Birmingham Boston Terrier Rescue Application to Adopt or Foster

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Phone Number

Area CodePhone Number

Home Phone Number

Area CodePhone Number

Work Phone Number

Area CodePhone Number

Typical work week schedule:

Defining Your Needs in a Dog:

Please tell us what your considerations are regarding a Boston Terrier or Boston Terrier Mix.

Have you ever been owned by a Boston Terrier?

YesNo

Which of the following are you wanting to do?

AdoptFosterBoth

Would you consider a mixed-breed dog?

YesNoMaybe

Would you consider a senior Boston Terrier?

YesNoMaybe

Would you consider a special-needs Boston Terrier or mix?

YesNoMaybe

Would you consider a Boston Terrier that is not fully house-trained at the point of adoption?

YesNoMaybe

Are you willing to teach basic obedience commands, such as "sit," "stay," and "down"?

YesNo

What research have you done on the Boston Terrier breed?

What Boston Terrier(s) or mixes are you interested in adopting?

Please tell us about your family and home environment. While Birmingham Boston Terrier Rescue will adopt a dog to a home with young children, we do carefully review the situation to be certain that the family situation and the dog are a good match so that the children are not put in danger. This said, it is the responsibility of the parents to safeguard thier children; and if at any point they feel the dog is a danger to their child (or the child to the dog), they must bring the dog back to the rescue.

Household Information:

How many adults live in your household? (Please list their ages)

How many children live in your household? (Please list their ages)

Do you have small children who visit your home frequently? (Please list their ages)

Home Environment:

Does anyone in your household smoke and if so, how much?

Do you have a doggie door installed leading to your backyard?

YesNo

What type of dwelling do you have (house owned, house rented, condo,townhouse, apartment, trailer, etc.)?

What is your dwelling's approximate square footage?

If you do not own your dwelling, do you have permission from your landlord and/or your tenants' association rules allow you to have a dog on the premises?

Do you have a backyard?

YesNo

If you have a backyard, approximately how large is your backyard (indicate weather measurement is given in square feet or in acreage?

If you have a backyard, is it entirely fenced?

If your backyard is entirely fenced, describe in detail the fence's specific construction (chain link fence, horizontal wooden slat fence, vertical wooden slat fence, etc.) the fence's height, and the spacing in inched between slats if fence is wooden.

Does the gate(s) that is built into your backyard fence remain closed at all times with suitable, sturdy hasp to preclude the gate from unintentionally opening?

Do you have a digital camera? (If you have a digital camera, please take several photos of your backyard, fence, & gate(s). Send these digital photos to boston@bhambtr.org)

YesNo

Narrative:

Please tell us a little about your lifestyle and any activities in which you would like for a Boston Terrier or Boston mix to be able to participate:

Please, explain why you want to adopt a Boston Terrier or Boston mix:

Pet History:

If you have pets or have had pets in the last 3 years, Birmingham Boston Terrier Rescuerequires a reference from your vet prior to adoption. We will need to know that all pets in your care are up to date with all required vaccinations and that all dogs in your care are on heartworm preventative and flea & tick preventative. Applications that do not provide complete veterinary information will be delayed. Please tell us about the pets you have recently owned.

Pet #1

Name:

What is this pet's status? (Living, Deceased, Ran Away, Rehomed)

Species:

Breed:

Gender:

FemaleMaleFemale/SpayedMale/Neutered

Is this pet up-to-date with Rabies, Distemper, & Parvo Vaccinations? (List date(s) these were given)

If this pet is not up-to-date, that is not within the past 12 months, with its Rabies, Distemper, and/or Parvo vaccinations, please explain why there is a lapse:

Is this pet receiving heartworm preventative?

YesNoNot sure

How often is the heartworm preventative administered? (Please list date given last)

Pet #2

Name:

What is this pet's status? (Living, Deceased, Ran Away, Rehomed)

Species:

Breed:

Gender:

Is this pet up-to-date with Rabies, Distemper, & Parvo Vaccinations? (List date(s) these were given)

If this pet is not up-to-date, that is not within the past 12 months, with its Rabies, Distemper, and/or Parvo vaccinations, please explain why there is a lapse:

Is this pet receiving heartworm preventative?

YesNoNot sure

How often is the heartworm preventative administered? (Please list date given last)

PET#3

Name:

What is this pet's status? (Living, Deceased, Ran Away, Rehomed)

Species:

Breed:

Gender:

FemaleMaleFemale/SpayedMale/Neutered

Is this pet up-to-date with Rabies, Distemper, & Parvo Vaccinations? (List date(s) these were given)

If this pet is not up-to-date, that is not within the past 12 months, with its Rabies, Distemper, and/or Parvo vaccinations, please explain why there is a lapse:

Is this pet receiving heartworm preventative?

YesNoNot sure

How often is the heartworm preventative administered? (Please list date given last)

Vet Care History:

Have you used a veterinarian for the pet(s) listed above within the last 3 years?

YesNO

If you answered no or n/a, then provide an explanation as to how medical care was provided to the pet(s) listed above:

If you answered yes, then complete the following section.

Name of primary veterinarian:

Name of primary veterinarian office or clinic:

Address for clinic: (Street/City/State/Zip Code)

Phone number of clinic: (Please be sure to include area code)

Name on account:

Name of pets in care of primary veterinarian:

Expectations for Adoptive Dogs:

If approved, please explain how you would care for your adopted Boston Terrier or Boston mix:

Will the Boston Terrier or Boston mix be allowed in the house?

If you answered yes, how many hours a day will the Boston Terrier or Boston mix be allowed in the house:

Will the Boston Terrier or Boston mix live solely outside?

YesNo

Where will the Boston Terrier or Boston mix stay when you are away from the house?

What is your work schedule (hours per day, days per week)?

Have you made arrangements with a family member, neighbor, or friend who will take care of the Boston Terrier or Boston mix? If yes, please explain.

Where will the Boston Terrier or Boston mix sleep at night?

What type of shelter will the Boston Terrier or Boston mix have access to while outside?

Are you familiar with the use of a dog crate to train and/or confine a Boston Terrier or Boston mix during your absence or at night?

YesNo

Are you willing to use a crate?

Are you aware that Boston Terriers and Boston mixes are active and that they shed hair all year long?

YesNo

Are you aware that routine costs of maintaining a pet averages $700+ yearly?

Where would your Boston Terrier or Boston mix stay when you are out of town?

What would you do with your Boston Terrier or Boston mix if you were to move?

What would you do with your Boston Terrier or Boston mix should you become unable to care for him/her?

Have you ever sold, given away, or surrendered a pet before? If you answered yes, please explain why.

Applications To Other Rescue Organizations:

Have you applied to any other canine rescue groups, including any other Boston Terrier Rescue groups?

YesNo

If you answered yes, which one(s) and what was/were the approximate date(s) of the applications? And the outcome of the application(s)?

The adoption application process consists of several steps:

*Fill out an on-line adoption or foster appication.
*Pay $10 application fee. PayPal: donations@bhambtr.org
*Veterinarian check performed by BhamBTR.
*Home visit performed by BhamBTR.
*Be patient during the application review process, which can take from a week to several weeks.
*If approved, then adoption fee is payable in full upon receipt of the Boston Terrier or Boston mix via cash, check, PayPal, or credit card.
*Read, understand, and sign adoption contract.

I have read and understand these steps above:

The submission of this application form does not guarantee that you will be approved to adopt a Boston Terrier or Boston mix from Bormingham Boston Terrier Rescue.

I authorize the aforementioned veterinarian and associated clinic personnel to release information about my pet(s) and its care to Birmingham Boston Terrier Rescue, Inc.

PRIVACY POLICY: Information given to Birmingham Boston Terrier Rescue, Inc., is confidential and will not be shared with ant individuals or organizations. Birmingahm Boston Terrier Rescue, Inc., does not sell or rent the information you provise online to third parties.

I, , swear or affirm that all the information on this application is true and correct. I further swear or affirm that nothing has been withheld that would adverselt affect my consideration in the adoption of a Boston Terrier, or any other dog, and that nothing in my background might disallow me from being considered for the adoption of a dog or any other animal. I swear or affirm that this dog is for my own personal enjoyment and is expected to be my dog and that I am not making this application for any third person or organization or group.

I, , futher swear or affirm that I have never been prosecuted, successfully or unsuccessfully, on animal cruelty or similar charges, am in good standing with law enforcement, have no outstanding arrest warrants, and that I have never been refused by any other dog rescue or dog adoption agency, animal shelter, or similar adoption agency of a dog or any other animal.

Electronically signed by:

Date

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