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The Boston Terrier Rescue Net is a 501c3
non-profit organization dedicated to fundraising to assist national Boston Terrier Rescue efforts.

Adoption Application

First Name*: Last Name *:
Address*: City*:
State*: Zip Code*:
Home Phone*: Best reached: Day Evening
Work Phone: Best reached: Day Evening
E-Mail Address*:    

How long at current address?
Do you: Own Home or Rent

*Renter must attach a copy of your lease or notarized statement from your landlord stating a pet this size is permitted.

If you move, what will you do with this animal?
Where will the pet be kept during the day?

Where will the pet be kept at night?
When no one is home?

When you are on vacation?

How long will the pet be left alone each day?

Exercise and elimination for pet will be:
(check all that apply)

On lead
On chain or trolley
Fenced yard (totally enclosed)
Partially fenced area
Electronic/radio fence
Loose in unfenced yard
Indoor potty area (papers, box)

How many adults live in the household? Ages:
How many children? Ages:

How many children visit? (grandchildren etc.)
Who will be responsible for caring for this animal?

Please call your vet’s office and give them permission to release your pets records to Boston Terrier Rescue.
*** Your application will not be processed if this information is not provided.
Veterinarian Name*: Veterinarian Phone*:
    Veterinarian Address*:

Please list two other references we may contact regarding this adoption:
Reference #1*
Reference #2*

Please list all pets you have owned in the past five years:
(if none, include pets owned in your adult life)

TYPE(Cat, Dog: Breed),Age,Gender,Spayed/Neutered? Where is it now?
If you have ever had a pet lost or die at an early age or due to accident, please give details:
Have you ever given a pet up? * Yes No
If yes, please explain the circumstances:
How much do you plan to spend on this animal each year? (Consider food, vet care, boarding, licensing, etc.)

Dog sought: MALE FEMALE No Preference
Prefer Must Have
Age desired:
Will you consider a dog over 3 years of age? Yes No
Over 6 years of age? Yes No
Over 10 years of age? Yes No
Will you consider a dog that is not housebroken? Yes No
One with health problems? Yes No
One with some behavior problems? Yes No
Are looks and size important? Yes No
If yes, please explain.
Do you agree to return this dog to the Boston Terrier Rescue if you are unable to keep it for any reason? * Yes No

Signature of all applicants residing in household:
Name: Date:
* *

* Indicates a required field.
If you experience any problems or have questions regarding this application form, please contact us by email.

Click here for a printable application form. You can copy & paste the application into an email & send it to  by email or print the application and mail to:

PO Box 734
New Albany, Ohio

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 after answering all the questions you would like to add more information please do so by sending an email to or if mailing an application on a separate sheet of paper.

Please note:
BTRN does not play any role in establishing adoption or placement fees for Boston Terrier Rescue Organizations.

Including a $5.00 US dollar donation along with your application is greatly
appreciated and will be used exclusively to help offset extraordinary expenses incurred in caring for rescued Bostons in foster care.

Please do not submit photos with your applications due to cost of postage when forwarding applications to the correct Rescue group. Thank you.

boston terrier rescue net