Boston Terrier Adoption Application

First Name* :	Last Name *:
Address*:	City*:
State*:	Zip Code*:
Home Phone*:	Best reached:	Day Evening
Work Phone:	Best reached:	Day Evening
E-Mail Address*:
Occupation:

How long at current address?
Do you: Own Home or Rent
*Renter must attach a copy of your lease or notarized statement from your landlord stating a pet this size is permitted.

If you move, what will you do with this animal?
Where will the pet be kept during the day?
Where will the pet be kept at night?
When no one is home?
When you are on vacation?
How long will the pet be left alone each day?

Exercise and elimination for pet will be:
(check all that apply)

On lead
On chain or trolley
Fenced yard (totally enclosed)
Partially fenced area
Electronic/radio fence
Loose in yard
Indoor potty area (papers, box)


How many adults live in the household?		Ages:
How many children?		Ages:
How many children visit? (grandchildren etc.)		Ages:
Who will be responsible for caring for this animal?

Veterinarian Name:		Veterinarian Phone:
Please list two other references we may contact regarding this adoption:

NAME

RELATIONSHIP

PHONE

BEST TIME TO CALL

Reference #1

Reference #2

Please list all pets you have owned in the past five years:
(if none, include pets owned in your adult life)

TYPE(Cat, Dog: Breed),Age,Gender,Spayed/Neutered? Where is it now?

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

Have you ever given a pet up? *	Yes No
If yes, please explain:


How much do you plan to spend on this animal each year? (Consider food, vet care, boarding, licensing, etc.)

Dog sought: MALE FEMALE No Preference
Prefer Must Have
Age desired:
Will you consider a dog over 3 years of age?	Yes	No
Over 6 years of age?	Yes	No
Over 10 years of age?	Yes	No
Will you consider dog that is not housebroken?	Yes	No
One with health problems?	Yes	No
One with some behavior problems?	Yes	No
Are looks and size important?	Yes	No
If yes, please explain.

Do you agree to return this dog to Boston Terrier Rescue of West Virginia if you are unable to keep it for any reason? *	Yes	No


THE BOSTON TERRIER RESCUE, BTHAVEN, RESERVES THE RIGHT TO REFUSE ANY APPLICATION. I certify that all the information on this application is true and complete. I understand that if chosen as an adoptive home, I will comply with the following conditions of adoption. 1. ADOPTER shall keep BOSTON as an indoor pet, and will provide BOSTON with identification at all times (collar, tag, tattoo or michrochip). BOSTON will be kept under control at all times when off ADOPTER's property. 2. ADOPTER shall provide adequate vertinary care for BOSTON including annual vaccinations, rabies vaccinations as needed, and any other care recommended by BOSTON's veterinarian. ADOPTER will take BOSTON to veterinarian if ill. If ADOPTER is unable to do so, ADOPTER will notify BTHAVEN rescue contact. 3. ADOPTER agrees to notify BTHAVEN rescue contact of any changes of address or telephone of ADOPTER. 4. If BOSTON is lost or stolen, ADOPTER will immediately notify BTHAVEN rescue contact. 5. ADOPTER shall return BOSTON to BTHAVEN rescue, if under any circumstances, ADOPTER is no longer able to keep or provide for BOSTON. ADOPTER shall not sell, give or otherwise transfer BOSTON to anyone other than BTHAVEN rescue. 6. ADOPTER REPRESENTS THAT NO MEMBER OF HOUSEHOLD HAS EVER BEEN CHARGED WITH CRUELTY TO ANIMALS. 7. ADOPTER shall indemnify and hold harmless BTHAVEN, Inc. and its members from any and all loss, damage or expense. BTHAVEN, INC. does not warrant the temperament or behavior of BOSTON. BTHAVEN, Inc. does not warrant the health of BOSTON. BTHAVEN, Inc. is not liable for acts of BOSTON after placement with adopter.

Signature of all applicants residing in household:
Name:	Date:
*	*

* Indicates a required field.
If you experience any problems or have questions regarding this application form, please contact us by email or phone.
Please complete and return application to:

BTHAVEN
Susan Hunter
304-864-3460
P.O. Box 1632
Morgantown, WV 26507

Printable Adoption Application
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