PLEASE NOTE: Completion of this application is the first step toward adopting a Boston Terrier. This application does not denote approval for adoption.
Please answer ALL of the questions. PleasePRINT LEGIBLY IN INK or TYPE your application. (DO NOT USE PENCIL). Check for mistakes since the rescue groups will be unable to contact you if your email address is not correct. We will not be able to process your
application if we are unable to read or scan it. Remember to include the name, address and phone number of Veterinarian. The rescue groups will not be able to process your application without this information.
In all probability, you will not receive any communication from your area Coordinator until a suitable Boston has been
found for your home. Our Coordinators are extremely busy and do not have the time to contact each applicant until they
have found a match.
Finding the right match will take time, so please bear with us as we work on your application.
If you would like to add more information please do so on a separate sheet of paper
after answering all of the questions.
Send to BTRN2000@insight.rr.com or mail to the BTRN address shown at end of application.
CONTACT INFORMATION
Name: ________________________________________________________________
Street Address: __________________________________________________________
City: ___________________________________________
State/Province: _________________________________________________________
Country: _____________________________ Zip/Postal Code: ______________________________
Ph - Day: ________________________
Ph - Eve: ________________________
Best Time To Call: _______________________
E-mail Address:_________________________________________
ADOPTION INFORMATION
How long have you been at your present address?: ____________________________________________
Do you own or rent?: ______________________________________________
*** Renters must attach a copy of your lease or notarized statement from your landlord stating that a pet of this size is permitted.
If you move, what will you do with your adopted Rescue?: _____________________________________
Occupation: _____________________________________
Where will the pet be kept during the day?: _____________________________________________
Where will the pet be kept at night?: ___________________________________________________
Where will the pet be kept when no one is at home?: ____________________________________
How long will the pet be left alone each day?: __________________________________________
How many adults live in your household?: ___________________________________________________
What are their ages?: ___________________________________________________
How many children?: ___________________________________________________
What are their ages?: ___________________________________________________
Will there be children visiting?: ___________________________________________________
Who will be responsible for caring for this animal?: __________________
Exercise and elimination will be:
(Check all that apply)
In Exercise Pen or Run?: _____________________________
On Lead?: _____________________________
On Chain or Trolley?: ________________________
Totally Enclosed Fenced Yard?: _________________________
Partially Fenced Area?: ______________________________
Electronic/Radio Fence?: ________________________________________
Loose in Unfenced Yard?: __________________________________________
Indoor Area (Papers, etc.)?: ______
Please list all pets you have owned in the past five years. (If none, include pets owned during your adult life.)
Type: __________________________________________
(Dog, Cat, Breed) __________________________________________
Age: __________
Gender: __________
Spayed/Neutered?: __________
Where is it Now?: __________________________________________
If you have ever had a pet lost or die at an early age or because of an accident, please give details:
_________________________________________________________________________________________________
Have you ever given a pet up?: ________________________________
If yes, please explain the circumstances: __________________
How much do you expect to spend on this animal each year?:
(Include food, vet care, boarding, licensing, grooming, etc)
____________________________________________________________________
Do you prefer a Male or Female?: ____________________________________
Does the sex of the rescue matter?: ________________________________
Desired Age?: _________________________
Would you consider a dog more than 3 years of age?: __________________________________
More than 6 years of age?: _________________________________
More than 10 years of age?: ______________________________________
Will you consider a dog that is not housebroken?: ___________________________________
Has health problems?: _____________________________________
Is appearance or size important?: _________________________________________
If yes, please explain: _________________________________________________
REFERENCE INFORMATION *** Your application will not be processed if this information is not provided.
Name of Veterinarian: ________________________________________________
Adress of Veterinarian: ________________________________________________
Phone of Veterinarian:
________________________________________________
Please list two other references we may contact regarding this adoption:
#1. Name: _________________________________
Relationship: _________________________________
Phone: _________________________________
Best Time to Call?: _________________________________
#2. Name: _________________________________
Relationship: _________________________________
Phone: _________________________________
Best Time to Call?: _________________________________
| Signature of Applicants Residing in Household |
Date |
| #1. ________________________________________________ | __________________ |
| #2. ________________________________________________ | __________________ |
| #3. ________________________________________________ | __________________ |
| Signature of Boston Terrier Rescue | Date Received |
| __________________________________________________ | ____________________ |
| __________________________________________________ | ____________________ |
BTRN does not play any role in establishing adoption or Including a $5.00 US dollar donation along with your application is greatly Please do not submit photos with your applications due to cost of postage when forwarding applications to the correct Rescue group. Thank you
Please send your donation to:
BTRN
placement fees for Boston Terrier Rescue Organizations.
appreciated and will be used exclusively to help offset extraordinary
expenses incurred in caring for rescued Bostons in foster care.
PO Box 734,
New Albany, Ohio
USA
43054