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{\*\generator Msftedit 5.41.15.1503;}\viewkind4\uc1\pard\sb100\sa100\qc\cf1\fs28 Wisconsin Boston Terrier Rescue Adoption Application\fs20\par
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CONTACT INFORMATION \line Name: \line Street Address: \line City: \line State/Province: \line Country: \line Zip/Postal Code: \line\line Ph - Day: \line Ph - Eve: \line Best Time To Call: \line\line E-mail Address: \line\line ADOPTION INFORMATION \line\line How long have you been at your present address?: \line Do you own or rent?: \line\line * Renters must attach a copy of your lease or notarized statement from your landlord stating that a pet of this size is permitted. \line\line If you move, what will you do with your adopted Rescue?: \line\line Will you agree to a home check prior to approval? \line If no, explain: \line\line\line Occupation: \line\line Where will the pet be kept during the day?: \line\line Where will the pet be kept at night?: \line\line Where will the pet be kept when no one is at home?: \line\line How long will the pet be left alone each day?: \line\line How many adults live in your household?: \line What are their ages?: \line How many children?: \line What are their ages?: \line Will there be children visiting?: \line\line Who will be responsible for caring for this animal?: \line\line Exercise and elimination will be: \line (Check all that apply) \line In Exercise Pen or Run?: \line On Lead?: \line On Chain or Trolley?: \line Totally Enclosed Fenced Yard?: \line Partially Fenced Area?: \line Electronic/Radio Fence?: \line Loose in Unfenced Yard?: \line Indoor Area (Papers, etc.)?: \line\line Please list all pets you currently own or have owned in the past five years: \line (If none, include pets owned during your adult life) \line\line #1. \line Type: \line (Dog, Cat, Breed) \line Age: \line Gender \line Spayed/Neutered?: \line Where is it Now?: \line\line #2. \line Type: \line (Dog, Cat, Breed) \line Age: \line Gender: \line Spayed/Neutered?: \line Where is it Now?: \line\line #3. \line Type: \line (Dog, Cat, Breed) \line Age: \line Gender: \line Spayed/Neutered?: \line Where is it Now?: \line\line If you have ever had a pet lost or die at an early age or because of an accident, please give details: \line\line\line Have you ever given a pet up?: \line If yes, please explain the circumstances: \line\line\line How much do you expect to spend on this animal each year?: \line (Include food, vet care, boarding, licensing, grooming, etc) \line\line Do you prefer a Male or Female?: \line Does the sex of the rescue matter?: \line\line Desired Age?: \line Would you consider a dog more than 3 years of age?: \line More than 6 years of age?: \line More than 10 years of age?: \line\line Will you consider a dog that is not housebroken?: \line Has health problems?: \line\line Is appearance or size important?: \line If yes, please explain: \line\line Do you agree to return this dog to Boston Terrier Rescue if you are unable to keep it for any reason?: \line\line REFERENCE INFORMATION \line\line Name and phone of Veterinarian: \line\line Please list two other references we may contact regarding this adoption: \line #1. \line Name: \line Relationship: \line Phone: \line Best Time to Call?: \line\line #2. \line Name: \line Relationship: \line Phone: \line\line Best Time to Call?: \cf0\f1\fs24\par
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