Southern California Boston Terrier Adoption Application

SOUTHERN CALIFORNIA BOSTON TERRIER RESCUE
ADOPTION APPLICATION

www.bostonbuddies.org

contactus@bostonbuddies.org

Please return completed application to:

Boston Buddies, Inc., 19051 Goldenwest St., #106-145,

Huntington Beach, CA 92648

Or Fax to (951) 677-7859

DATE

Thank you for your interest in our rescue dogs. We would appreciate your answers to the following questions so we can select the appropriate dog for you. All information is confidential. Thank you for your cooperation and we look forward to helping you find the right Boston Terrier for you and your family. Once we have received your application and it has been reviewed and approved for further processing, a volunteer will contact you to schedule the required home check visit. Please understand that we all do this rescue work on a volunteer basis and we will get to your application as soon as we can.

Name: Your age:

Address:

(City) (State) (Zip)

Phone:

(Home) (Work) (Cell)

Email: Best Time To Reach You:

FAMILY DATA:

Single Married

If married, does spouse approve of adopting this dog? Yes No

Comments:

Children: Please note that Boston Buddies has a policy of not placing its dogs in homes with children under the age of eight.

Number /Ages: Boys Girls

Others in household who will have contact with the dog:

Why are you interested in adopting a Boston Terrier?

What qualities do you like in the Boston Terrier?

What qualities or traits don’t you want to find in a Boston Terrier?

Have you ever owned a Boston Terrier before? Yes No

If no, are you aware of the special needs of the Boston Terrier breed? Yes No

Are you committed to caring for this dog for its lifetime?

Yes No

Where will the dog stay during the day?

How long will the dog be left alone during the day? Hours days a week

Will the dog have access to the house AND yard while left alone: Yes No

If no, who will let the dog out?

Do you have a dog sitter? Dog walker? Doggie Door?

Where will the dog sleep?

Will the dog be allowed on the furniture? Yes No

Do you own your own home or rent? Own Rent

Apartment Home Condo

Does landlord approve of dogs on property Yes No

If you rent, landlord name and number:

Do you have a fenced in yard? Yes No Kind of fence: Height:

If you do not have a fence, how are you going to exercise this dog?:

Are you interested in:

A Boston Buddies Dog Listed on Petfinders? If yes, which one:

Please realize that there is no guarantee that the dog you are interested in will still be available once your application is approved or that the dog is the right dog for you and your specific circumstances.

A puppy? Yes No (Please realize that most of our rescues are over 1 year old)

Older dog? Yes No Acceptable Age Range:

Male: Female: No Preference:

Would you consider a deaf Boston? Yes No

Would you accept one with health problems? Yes No

If yes, what kinds of health problems are acceptable? (Check all that apply).

Allergies Arthritis Balance problems Blindness Deafness Ear discharge Epilepsy Hair Loss Heart disease Incontinence Limping One-eyed Scars Skin Problems Snorting Special Diet Spinal Deformity Three Legged Separation Anxiety

Would you consider a Boston mix? Yes No

Would you adopt two dogs that have come from the same home & need to stay together? Yes No

Should your new pet be (check all that apply)--

Dog friendly Cat friendly Doesn't Matter

Previously owned dogs:

Dogs present in the home now (Breed, Age, Sex):

Are they spayed/neutered? Yes No

If NO, why not:

Other pets currently owned and living in household:

Are your current pets up to date on their annual vaccinations? Yes No

Are your current pets on heartworm preventative? Yes No

If NO, why not?

In addition to the pets identified above, what other pets have you owned in the last 5 years?

If you have not owned ANY pets in the past 5 years, have you EVER owned any pets? Yes No

If Yes, when and tell me about them:

Why do you No longer have these pets?

Do you have any experience with formal obedience training of dogs? Yes No

If yes, please explain the methods of training and where you learned how to train a dog:

Have you filled out an adoption application with any other rescue organization? Yes No

If so, to whom have you applied to and when?

Have you adopted a dog from Rescue in the past? Yes No

If so, from whom and when did you adopt? (Name and contact number)

How did you hear about Boston Terrier Rescue?

My Veterinarian Obedience/Agility/Breed Trials
American Kennel Club Friend
Humane Society Other (Please list)

Personal references:

Name:

Phone Number:

Name:

Phone Number:

RELEASE FOR VETERINARY REFERENCE:

I, , hereby give permission for any veterinarian providing service to me/my animals to release medical information on any/all of my animals to Boston Buddies, Inc., Southern California Boston Terrier Rescue

My current veterinarian is:

Name:

Address:

Telephone:

This release is Not limited to the veterinarian named above. PLEASE LET YOUR VET KNOW WE WILL BE CALLING FOR A VET REFERENCE.

Applicants without a current vet must list the vet they plan to use. Applications submitted without this information will be discarded:

Name:

Address:

Telephone: