"Growing Old With You" Application for Dogs that are Currently Owned and Seeking Funding Assistance

This application is for boxer owners who are applying for funding to help you keep your existing senior boxer

Date: Date: / MM / DD YYYY
CONTACT INFORMATION
Your name: Your name: First Last
Your email address:

This is so that we may contact you with questions about your listing.
Your phone number: Your phone number: - ### - ### ####

This will be posted in your listing.
Your Physical Address: Your Physical Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Your Mailing Address, if different: Your Mailing Address, if different:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
DOG'S INFORMATION
Boxer's Name:
Boxer's Sex

Boxer's Sex Female Male
Approximate Age of the boxer?
How long have you had your boxer?
Where did you first get your boxer?
Are you considering giving up your boxer because you can't afford their vet care?
Is your dog spayed/neutered?

Is your dog spayed/neutered? Yes No Unsure

We will not post dogs that are not spayed/neutered. Proof must be provided.
Is your dog microchipped?

Is your dog microchipped? Yes No Unsure

We will not post dogs that are not spayed/neutered. Proof must be provided.
Is the dog current on Rabies, Distemper/Parvo vaccinations?

Is the dog current on Rabies, Distemper/Parvo vaccinations? Yes No Unsure

We will not post dogs that are not spayed/neutered. Proof must be provided.
VET CARE QUESTIONS
What veterinary care does your boxer need and how do you know?
Has your dog already been seen by a vet?

Has your dog already been seen by a vet? Yes No

We will not post dogs that are not spayed/neutered. Proof must be provided.
Please provide the name and contact information of the vet you will be using for veterinary services. If you do not yet know which vet to use, please let us know.
ELIGIBILITY
Are you willing to provide updates on how your boxer is doing?
Are you committed to keeping your boxer for the remainder of his or her life?
OTHER
Where did you learn about NorCal Boxer Rescue's "Growing Old With You" program? (please name the specific location)
PICTURES
Attach up to 3 pictures of the boxer you have adopted or are planning on adopting

Attach Files

"Growing Old With You" Application for Dogs that are Currently Owned and Seeking Funding Assistance

"Growing Old With You" Application for Dogs that are Currently Owned and Seeking Funding Assistance

CONTACT INFORMATION

DOG'S INFORMATION

VET CARE QUESTIONS

ELIGIBILITY

OTHER

PICTURES