Boston Terrier Rescue Net - Adoption Application

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Home Phone*

Area CodePhone Number

Best time to call*

DayEvening

Work Phone

Area CodePhone Number

Best time to call*

DayEvening

Occupation*

At current address since*

MonthDayYear

Do you*

Own a homeRentOther (Explain)

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

Please clarify your current living situation.*

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)*

How many adults live in the household?*

Ages of adults*

How many children?*

Ages of children*

How many children visit? (grandchildren etc.) *

Ages of visiting children*

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*

First NameLast Name

Veterinarian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Veterinarian Phone*

Area CodePhone Number

* Please list two other references we may contact regarding this adoption.

Reference 1

Full Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Best time to call*

DayEvening

Reference 2

Full Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Best time to call*

DayEvening

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

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?*

YesNo

If yes, please explain the circumstances:*

How much do you plan to spend on this animal each year? If you need help calculating this amount, take a look at the Pet Cost Calculator linked at the top of this page.*

Sex*

No PreferenceMaleFemale

Age of dog desired*

Will you consider a dog over 3 years of age?*

YesNo

Over 6 years of age?*

YesNo

Over 10 years of age?*

YesNo

Will you consider a dog that is not housebroken?*

YesNo

One with health problems?*

YesNo

One with some behavior problems?*

YesNo

Are looks and size important?*

YesNo

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?*

YesNo

* Please provide signatures for each member of your household acknowledging the above form. You may either print out the form and sign and mail it to us or enter your initials in the electronic fields.

Name

Date

Name

Date

Name

Date

Name

Date

Name

Date

If you experience any problems or have questions regarding this application form, please contact us.

You may print out the application form and mail it to:

BTRN
P.O.Box 734
New Albany, Ohio
43054

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 BTRN 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 optional, but 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.

Adoption Application

CONTACT INFORMATION

ADOPTION INFORMATION

REFERENCE INFORMATION

Dog sought