Personal & Family Information:
Your full name (first/last):
Your email address:
Webpage (if you have one):
Address:
City:
Province/State:
Postal/Zip Code:
Country:
Home Phone:
Alternative Phone:
Fax:
Occupation:
Name of Employer:
Do you work full or part time?
Do you have any children living in the home?
Yes
No
If yes please list their ages.
Have the children been raised with a dog or any other pet?
Yes
No
I don't have any children
Have you ever owned a Boxer?
Yes
No
For how long?
Do you still have your Boxer?
Yes
No
If no please explain what happened to your Boxer (ie. died, cause of death, given away, placed, lost, stolen, etc.).
Do you currently or previously owned another breed of dog?
Yes
No
If yes please list each breed, the age, if alive or deceased (include cause of death), if spayed, neutered or intact.
Do you own a cat?
Yes
No
Not right now but perhaps in the future
If yes how many?
Is the cat (or cats) declawed?
Yes
No
I don't have a cat
Do you have any other type of pet?
Yes
No
If yes what type of pet?
If you currently have a pet (or pets), is it spayed or neutered?
Yes
No
I don't have any pets at this time
If no please explain why.
Housing Information:
What type of dwelling do you live in?
Apartment
Basement Suite
Condo
Duplex
House (in the city)
House (in the country)
Mobile
Townhouse
Other
If other dwelling please specify.
How long have you lived at current address?
At your current address do you?
Lease
Own
Rent
If you lease or rent does your agreement allow you to have pets?
Yes
No
I don't lease or rent
If your lease or rental agreement allows pets, are there any restrictions (ie. size of dog, number of pets, etc.)?
Yes
No
I don't have a lease or rental agreement
What are the restrictions?
Landlord's name (if leasing or renting):
Landlord's phone number (if leasing or renting):
Do you have a fenced yard?
Yes
No
Currently building a fence
Currently in the planning stages to fence yard
What type of fencing do you have?
Chain Link
Wood
Other
Specify your "other" type of fencing:
Specify the height of the fence:
If you don't have a fence how will you exercise your Boxer and how often?
Do you have an outdoor kennel or run?
Yes
No
Plan to put in a dog kennel or run
Do you have a doggy door?
Yes
No
Dog/Puppy Care & Training Info:
In addition to the purchase price of your Boxer and the basic supplies (collar & leash, bedding, crate, dish, etc.), are you financially able to (check all that apply):
Enroll in a conformation class (if showing)
Enroll in a basic obedience class
Feed a quality food
Have health testing done (if breeding)
License your Boxer yearly
Pay for show entries (if showing)
Provide proper veterinary care
Spay or neuter your Boxer
Who will be the dog/puppy's primary caregiver?
Myself
Spouse
Child
Every person in the house
Will your children be actively involved in the care & training of the dog/puppy?
Yes
No
I don't have any children
Where will the dog/puppy be during the day?
Basement
Doggy Daycare
Garage, in a crate
Garage, in an indoor kennel run
Garage, loose
Inside, in a crate
Inside, in an indoor kennel run
Inside, loose
Kennel with indoor & outdoor runs
Outdoors, in a kennel run
Tied up in yard
Other (please specify)
Daytime "other":
How many hours during the day will the dog/puppy be alone?
0-1 hours
1-2 hours
2-3 hours
4-5 hours
5-6 hours
6-7 hours
7-8 hours
8-9 hours
More than 9 hours
If the dog/puppy will be alone during the day for more than 9 hours please explain why:
Where will the dog/puppy be during the evening?
Basement
Garage, in a crate
Garage, in an indoor kennel run
Garage, loose
Inside, in a crate
Inside, in an indoor kennel run
Inside, loose
Kennel with indoor & outdoor runs
Outdoors, in a kennel run
Tied up in yard
Other (please specify)
Evening "other":
How many hours during the evening will the dog/puppy be alone?
0-1 hours
1-2 hours
2-3 hours
4-5 hours
5-6 hours
6-7 hours
7-8 hours
8-9 hours
More than 9 hours
If the dog/puppy will be alone during the evening for more than 9 hours please explain why:
Where will your dog/puppy sleep at night?
Basement
Garage, in a crate
Garage, in an indoor kennel run
Garage, loose
In my bed
Inside, in a crate
Inside, in an indoor kennel run
Inside, loose
Kennel with indoor & outdoor runs
Outdoors, in a kennel run
Tied up in yard
Other (please specify)
Nighttime "other":
When you are away on for any length of time (overnight, on vacation, etc.), who will care for the dog/puppy?
Boarding Kennel
Pet Sitter
Relative
Other (please specify)
Away "other":
Will you crate train your Boxer?
Yes
No
I'm not familar with crate training
If no, please explain your reason(s) for not crate training:
Other Information:
Why have you chosen the Boxer as the breed for you?
Are you familiar with the breed?
Yes
No
Still learning
If yes where did you get the information?
Book(s)
Breeder(s)
Internet
Magazine(s)
All Of The Above
Other (please specify)
Information "other":
Are you aware of the health issues with this breed?
Yes
No
If yes where did you get the information?
Book(s)
Breeder(s)
Internet
Magazine(s)
All Of The Above
Other (please specify)
Please list the health issues you are aware of.
If you answered no to one or both questions above, would you like to receive info on book(s), magazine(s), etc., to read?
Yes
No
Do you want a dog/puppy out of parents that are fully health tested for the health issues Boxers have?
Yes
No
Doesn't matter
How important is it that your dog/puppy come from parents who are fully health tested for the health issues Boxers have on a scale of 1 to 10 (10 being the highest importance)?
10
9
8
7
6
5
4
3
2
1
Don't care
Have you or any person in your immediate family ever been charged and/or convicted of cruelty to animals?
Yes
No
If you answered yes please explain why:
Have you ever given up a dog to rescue, a pound or a shelter?
Yes
No
If you answered yes please explain why:
How did you find CynTech Boxers Perm. Reg'd?
Breeder Referral
Club Referral
Email List (please specify which list)
From A Friend
From A Link On Another Website
Guestbook Link
Just Surfed On In
Search Engine
Other (please specify)
Email list or other:
Dog/Puppy Information:
What are you looking for?
Breeding/Show Adult
Breeding/Show Potential Puppy
Companion/Pet Adult
Companion/Pet Puppy
Agility Prospect
Obedience Prospect
No Preference
Not Sure
Other (please specify)
If other, please explain.
What sex do you prefer?
Female
Male
No Preference
Not Sure
Would you consider a different sex if your preference is not available?
Yes
No
What color do you prefer?
Brindle with white markings (flashy)
Brindle with little or no white markings (plain/solid)
Fawn with white markings (flashy)
Fawn with little or no white markings (plain/solid)
Check (Brindle or fawn patches on a white body)
White
No Preference
Would you consider another color if your preference is not available?
Yes
No
When are you wanting a dog or puppy?
Immediately
1-3 months
3-6 months
6-9 months
9-12 months
Willing to wait
Do you want your Boxer's ears cropped? (ear cropping is an additional expense)
Yes
No
Unsure
If yes are you willing to learn the proper ear care and how to post the ears even if you have to travel some distance?
Yes
No
If no are you aware that natural ears may need some taping to help them lie correctly?
Yes
No
Our companion/pet dogs/puppies are sold on a spay/neuter contract with us and on non-breeding agreement with the Canadian Kennel Club (CKC). Would this be a problem for you?
Yes
No
If yes please explain why.
What qualities are you specifically looking for in the Boxer dog/puppy you want to bring into your home?
Would you agree to a home check prior to a dog/puppy being placed in your home?
Yes
No
Are you currently on any other waiting list for a dog or puppy?
Yes
No
If yes please list the names of the breeder(s) whose waiting list you are on & for how long.
References:
Name of personal reference (long time friend or family):
Personal reference phone number:
How long have you known your personal reference?
Reference (someone who has known your pets and you as a pet owner such as a handler or neighbor, etc.):
Reference phone number:
How long have you known your reference?
Veterinary Reference:
Name of your veterinary clinic (past or present):
Name of your veterinarian:
Your vet's phone number:
How long have you been a client?