*Indicates A Required Field
*First Name:
*Last Name:
*Street Address:
*City:
*State:
*ZIP Code:
Home Phone:
Work Phone:
Cellular Phone:
*Email Address:
*Confirm Email Address:
*I have read and do understand the Requirements on the preceding page: Yes No
Is there a particular Boston Terrier you are interested in? Yes No
What is his/her name?
Would you consider a mixed-breed dog? Yes No
Would you consider a senior Boston Terrier? Yes No
Would you consider a special-needs Boston Terrier? Yes No
Would you consider a Boston Terrier that is not fully house trained at the point of adoption? Yes No
Please tell us about your home and family. Note that for the safety of the child and the dog, it is ABTR's policy not adopt to families with children under the age of 5 years old.
*How many adults live in your household?
Please list their ages:
*How many children live in your household?
*Do you have small children who visit your home frequently? Yes No
Does anyone in your household smoke? Yes No
Do you rent or own your home? Rent Own
If you rent, do you have permission from your landlord to own a pet? Yes No
Do you have a backyard? Yes No
Is your yard fenced? Yes No
Approximately how large is your backyard?
ABTR requires a reference from your vet prior to adoption. We will need to know that all pets in your care are current on all required vaccinations and that all dogs in your care are on heartworm preventative. Applications that do not provide complete veterinary information will not be considered. Please tell us about the pets you have recently owned.
Name:
Species:
Breed:
Sex: Male Female
Spayed/Neutered: Yes No
Where is this pet now?:
Name of animal clinic:
Name of primary veterinarian:
Location:
Phone Number:
Name of account:
Please tell us how you will care for your adopted Boston Terrier.
*Will the Boston Terrier be allowed in the house? Yes No
*Will the Boston Terrier live solely outside? Yes No
Where will the Boston Terrier stay when you are away from the house?
Where will the Boston Terrier sleep at night?
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
Are you aware that Boston Terriers are active and that they shed hard all year long? Yes No
Are you aware that routine costs of maintaining a Boston Terrier averages $500 yearly? Yes No
Where would your Boston Terrier stay when you are out of town?
What would you do with your Boston Terrier if you were to move?
What would you do with your Boston Terrier should you become unable to care for him/her?
Have you ever sold, given away, or surrendered a pet to a shelter? Yes No
Please explain why:
Please tell us a little about your lifestyle and any activities that you would like for your Boston Terrier to be able to participate in:
Please explain why you want to adopt a Boston Terrier:
Have you applied to any other Boston Terrier Rescue groups? Yes No
Please list the name of the group(s):
*Electronically Signed By:
Date Signed: Choose the Month January February March April May June July August September October November December Choose the Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
