ADOPTION APPLICATION

Which Boston Terrier are you interested in? List 'open' if submitting a general inquiry application.

First Name

Last Name

Phone

Employer/Occupation

Address

City

State / Province / Region

Postal / Zip Code

First Name (Joint Applicant) (optional)

Last Name (Joint Applicant) (optional)

Phone (optional)

Email (optional)

Employer/Occupation (optional)

Type of dwelling:

House

Apartment

Other

If Other-Describe

Do you own or rent?

Own

Rent

If renting, provide Name & Phone # for your Landlord

If you move, what will you do with your adopted dog?

How many children reside in the residence?

Names & Ages of ALL residents-Including Applicant(s) and your relationship to all residents. (self, spouse, children, siblings, parent, roommate, etc.)

Is anyone in your home allergic to animals?

Yes

If Yes, What animals?

Do you have other dogs at this time?

Yes

Do you have cats at this time?

Yes

Are all of your pets spayed or neutered?

Yes

If you have an un-altered pet, please explain why:

Please list the name, type of pet, breed, gender, & age of all of the pets in your home: (If none, list N/A)

Have you ever had to rehome a pet?

Yes

If you have had to rehome a pet, please describe the circumstances:

If you have owned pets in the past and do not now, what happened to them?

How many hours per day on average will your dog be left alone?

Where will your dog be kept when nobody is home?

Where will you keep your dog during the day?

Where will you keep your dog at night?

Does your home have a dog door?

Yes

Does your home have a fenced yard?

Yes

If you do not have a yard, please explain how you will allow your dog to exercise and relieve itself:

Do you have a swimming pool?

Yes

Does your pool have a safety fence?

Yes

N/A

Pool Alarm

Do you have a gender preference?

No preference

Male

Female

Have you owned a Boston Terrier before?

Yes

If you have not owned a Boston Terrier before, why are you interested in adopting a Boston Terrier?

What age ranges would you consider? Select all that apply

Puppy: under 1yr

Young: 1-4yrs

Adult: 5-8yrs

Senior: 9+yrs

Other

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

Would you take a dog that is NOT house broken?

Yes

Other

Would your dog be allowed on the furniture?

Yes

Do you plan for your dog to go to the Dog Park or to Doggie Day Care?

Yes

What energy level/activity level do you want your dog to be?

Full of energy-needs lots of activity

Moderate energy-plays then hangs out

Low energy- couch potato

Other-Describe

What kinds activities do you plan to do with your dog?

Other-Describe

What kinds of medical issues are you willing to accept?

Allergies

Skin Problems

Arthritis

Mobility difficulties

Blind

Deaf

Seizures

Incontinence

Other-Describe

What brand of food do you plan to feed your dog?

How much do you anticipate to be the yearly cost of owning a Boston Terrier (including but not limited to food, supplies and vet care)?

Do you plan to get pet health insurance?

Yes

Unknown

Other

Veterinary clinic name & phone #: List N/A if no current vet

Do you give permission for us to contact your Veterinarian?

Yes

I, (please print your whole name in box below), hereby give permission for any veterinarian providing service to me/my animals to release medical information on any/all of my animals to the Southern Nevada Boston Terrier Rescue.

Please tell us more about yourself! Is there anything else that we should know about you to help us make the perfect match?

What circumstances would cause you to have to return the dog?

Do you understand that although you may have read a brief description about a particular dog on our website, that dog may have some personality traits that are not the most suitable for your family situation and dynamics?

Yes

Do you understand that there is a chance that the dog you were originally interested in will be placed in an approved home prior to the completion of your application review and home check?

Yes

Please Type Your Full Name In The Box Below

Today's Date

Adopted

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