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ADOPTION APPLICATION FORM

~~~ Click the submit button below after filling out this form. ~~~
~~~ ABTR will only adopt Boston Terriers to the following states: ~~~
~~~ Alabama, Georgia, Mississippi, Tennessee, Northern Florida, and Louisiana. ~~~

First Name
Last Name
Home Address
City
State (see note below)
Zip
Home Phone
Work Phone
Cellular Phone
e-Mail

I have read and do understand the Owner Expectations on the preceding page.		Yes			No
Is there a particular Boston Terrier, either form our website or from Petfinder.com, that you are interested in adopting?
A complete answer to the following questions will enable us to more specifically understand your request and requirements, and will help us find a Boston Terrier to match your needs and expectations.
What age would you prefer?		Puppy	Young	Adult	Senior
Would you consider a special-needs Boston Terrier, such as one requiring medication for a permanent but controlled condition?		Yes			No
Will you accept a Boston Terrier mixed-breed?		Yes			No
What color would you prefer?		Light	Medium	Dark	Brindle
Do you have any children or family members living at home with you?		Yes		Ages	No
If so, do they share your interest in adopting a Boston Terrier?		Yes			No
Whom is the Boston Terrier for?		Child	Adult	Elderly	Challenged
Who will care for, train, and exercise the Boston Terrier?
Does anyone in your household have allergies?		Yes		Type	No
May we visit your home prior to application approval?		Yes		When	No
Please list all the pets you have owned during the past three years?
Species	Sex	Spayed/Neutered			Outcome of pet?
		Yes		No
		Yes		No
		Yes		No
Please identify any veterinarians whom you have used over the past three years?
Name		Address			Phone




How long have you lived at your current address?		Own		Rent	Landlord
If you rent, do you have permission from your landlord to own a dog?		Yes		Size (lbs.)	No

Will the Boston Terrier be allowed in the house?		Yes			No
Where will the Boston Terrier stay when you are away from the house?
Will your Boston Terrier have the run of the house?				Yes	No
Will the Boston Terrier be in blocked-off parts of the house?				Yes	No
Will the Boston Terrier be tied outside?				Yes	No
Will the Boston Terrier live solely outside?				Yes	No
What type of shelter will the Boston Terrier have access to while outside?
Are you familiar with the use of a dog crate to train and/or confine a Boston Terrier during your absence or at night?				Yes	No
Are you willing to use a crate?				Yes	No
Is your yard fenced?			Yes	Type	No
If your yard is not fenced, are you willing to install a fence?				Yes	No
What is the size (approximate sq. ft.) of your yard's area?
Will the Boston Terrier be walked daily?				Yes	No
Will the Boston Terrier receive formal obedience training?				Yes	No
Have you ever owned a Boston Terrier?				Yes	No
Are you aware that Boston Terriers are active and that they shed hair all year long?				Yes	No
Are you aware that routine costs of maintaining a Boston Terrier average $500 yearly?				Yes	No
Have you sold, given away, or surrendered a pet to a shelter?			Yes	Explain	No
Please explain why you want a Boston Terrier.
Please tell us a little of your lifestyle and your family's, including any special activities in which a Boston Terrier would be included.
If you have any special requirements or requests for a particular type of Boston Terrier, please let us know so that we may more carefully match a Boston Terrier to your lifestyle.
If you move, what will you do with the Boston Terrier?

Do you understand the state and local ordinances concerning licensing?				Yes	No
Do you understand the state and local ordinances concerning leashing?				Yes	No
Have you, or any member of your family/household, been cited for leash-law violations or cruelty to animals?				Yes	No

Have you applied to any other Boston Terrier Rescue groups?			Yes	List	No
I attest that the information provided on this application is true and accurate to the best of my knowledge. I also understand that completion and submittal of this application does not guarantee adoption of a Boston Terrier. I understand that if I am approved, there is a $225 adoption fee, payable upon receipt of Boston Terrier.
Electronically signed by					Date
Note: Out-of-state applicants who are approved are required to pick up the Boston Terrier at its Alabama location or to make arrangements to have the Boston Terrier transported to its final destination.