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. 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.

To Email:
Cut and paste the questions below into your email program & answer all questions. If you would like to add more information please do so after answering all the questions.

Send to

To Mail:
Print this page and answer all of the questions. If you would like to add more information please do so on a separate sheet of paper after answering all of the questions.
If mailing this application please PRINT LEGIBLY IN INK or TYPE your application. (DO NOT USE PENCIL).

PO Box 734
New Albany, Ohio



Name: ________________________________________________________________  

Street Address: __________________________________________________________

City: ___________________________________________

 State/Province: _________________________________________________________

Country: _____________________________  Zip/Postal Code: ____________________

Phone - Day: ________________________

Phone - Eve: ________________________

Best Time To Call: _______________________  

E-mail Address:_________________________________________ 


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.

Occupation: _____________________________________

If you move, what will you do with your adopted Rescue?____________________________

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: __________


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: _________________________________________________

*** Your application will not be processed if this information is not provided.

Please call your vet’s office and give them permission to release your pets records to Boston Terrier Rescue

Name of Veterinarian: ________________________________________________

Address 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