Make your own free website on Tripod.com
Midwest Boston Terrier Rescue Site

HOME

Adoption Application

Click file below to download application or copy and paste it to your email.  Please send application to jlemoine@new.rr.com 

click here to download file

Wisconsin Boston Terrier Rescue Adoption Application

 

 

CONTACT INFORMATION
Name:
Street Address:
City:
State/Province:
Country:
Zip/Postal Code:

Ph - Day:
Ph - Eve:
Best Time To Call:

E-mail Address:

ADOPTION INFORMATION

How long have you been at your present address?:
Do you own or rent?:

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

If you move, what will you do with your adopted Rescue?:

Will you agree to a home check prior to approval?
If no, explain:


Occupation:

Where will the pet be kept during the day?:

Where will the pet be kept at night?:

Where will the pet be kept when no one is at home?:

How long will the pet be left alone each day?:

How many adults live in your household?:
What are their ages?:
How many children?:
What are their ages?:
Will there be children visiting?:

Who will be responsible for caring for this animal?:

Exercise and elimination will be:
(Check all that apply)
In Exercise Pen or Run?:
On Lead?:
On Chain or Trolley?:
Totally Enclosed Fenced Yard?:
Partially Fenced Area?:
Electronic/Radio Fence?:
Loose in Unfenced Yard?:
Indoor Area (Papers, etc.)?:

Please list all pets you currently own or have owned in the past five years:
(If none, include pets owned during your adult life)

#1.
Type:
(Dog, Cat, Breed)
Age:
Gender
Spayed/Neutered?:
Where is it Now?:

#2.
Type:
(Dog, Cat, Breed)
Age:
Gender:
Spayed/Neutered?:
Where is it Now?:

#3.
Type:
(Dog, Cat, Breed)
Age:
Gender:
Spayed/Neutered?:
Where is it Now?:

If you have ever had a pet lost or die at an early age or because of an accident, please give details:


Have you ever given a pet up?:
If yes, please explain the circumstances:


How much do you expect to spend on this animal each year?:
(Include food, vet care, boarding, licensing, grooming, etc)

Do you prefer a Male or Female?:
Does the sex of the rescue matter?:

Desired Age?:
Would you consider a dog more than 3 years of age?:
More than 6 years of age?:
More than 10 years of age?:

Will you consider a dog that is not housebroken?:
Has health problems?:

Is appearance or size important?:
If yes, please explain:

Do you agree to return this dog to Boston Terrier Rescue if you are unable to keep it for any reason?:

REFERENCE INFORMATION

Name and phone of Veterinarian:

Please list two other references we may contact regarding this adoption:
#1.
Name:
Relationship:
Phone:
Best Time to Call?:

#2.
Name:
Relationship:
Phone:

Best Time to Call?:

Enter supporting content here