Rescue Dog Adoption Application

Adopt Foster
First Name
Last Name
Address
City
State
Zip Code
Email
Phone
Fax
Best time to call
How long at current address?
What is your occupation?

If there is more than one adult in household, fill out the following questions.

Adult #2 in household: Name, Phone, Occupation, Best time to call
Adult #3 in household: Name, Phone, Occupation, Best time to call
Own Rent
If renting, provide landlord name and phone number?
Where will the pet be kept during the day while no one is home?
Where at night?
When no one is home (weekends, during errands, etc.)?
When you are on vacation?
Will your pet be crated? Yes No
If so, for how long (on average)?
What type of crate do you have or plan to use?
How long will pet be left alone each day?
Do you have a totally fenced yard? Yes No
If so, what is the height?
What type of fence do you have?
Do you have a doggie door? Yes No
Are all exterior gates padlocked? Yes No

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

On lead or leash?
Tie-out or chain/trolley
Fenced yard (totally enclosed)
Partially fenced area
Electronic/invisible fence
Loose in yard
Indoor potty area (papers, box)
Other
Do you have a pool, hot tub, spa, pond or fountain? Yes No
If so, please describe
Pool Type Above Ground In Ground
Is the area separately fenced? Yes No
If not, how will your rescue be protected from this area?
What are the ages of the adults in your household?
What are the ages of the children in your household?
Do any children visit on a regular basis? Yes No
If so, what are their ages?
Who will be primarily responsible for caring for this animal?

Veterinarian

Please list your veterinarian names and phone numbers
for all animals you have owned in the past ten years:
Under what name(s) are your vet records listed?
Please Sign Here To Authorize Your Veterinarian To Release Any And All Medical Records On Your Pets To Boston Terrier Rescue For Purposes Of This Application (please note by typing your name(s), this is the same as your written signature(s)):

Please list three references we may contact as well (maximum one family member)

Reference #1 (Name, Address, Phone)
Reference #1 (Name, Address, Phone)
Reference #1 (Name, Address, Phone)
Please list all pets you have owned in the past ten years (if none, please list any pets owned in your adult life, or if you would like to list previous childhood pets, please note them separately): Type (cat, dog), Breed, Name, Age, Gender, Spayed/Neutered?
If any of your pets are now deceased, please give name, age at death, and cause of death
Are your pets presently on heartworm preventative? Or if your pets are deceased, were they on heartworm preventative while alive?
Yes No
If so, please list brand used and how often given
Have you ever lost a pet or had a pet die at an early age or due to accident, injury or unexpected illness?
Yes No
If so, please give details.
Have you ever surrendered or given a pet up?
Yes No
If so, describe the circumstances surrounding the surrender of your pet
If your pet was given to another person, give that person's name and contact information
Do you own any exotic pets (birds, reptiles, etc.)?
Yes No
If yes, please list each exotic pet owned and give a description of the pet
Dog sought: Please check your choice:
Male Female No Preference
If there is a specific rescue you are interested in adopting, please list his/her name and please list a second choice as well:
Have you applied to adopt from any other rescue group, shelter or breeder? If so, please state to whom.
(We process all applications in the order that they are received, and many times an application has been approved before the website is updated. To avoid delays in processing your application, please be sure that all questions are completely answered.)
Do you agree to return this dog to Boston Terrier Rescue of Greater Houston if you are unable to keep it for any reason?
Yes No
If you are an out-of-state applicant, please state how you intend to transport the rescue.
PLEASE NOTE: ONCE APPROVED, THERE IS A NON-REFUNDABLE ADOPTION FEE FOR ALL RESCUES. THE ADOPTION FEE IS USED SOLELY FOR THE MEDICAL CARE AND TREATMENT OF ALL OF OUR RESCUE DOGS, AND IS STATED UNDER THE PET’S ONLINE PROFILE.

INCOMPLETE APPLICATIONS MAY CAUSE A DELAY IN PROCESSING. PLEASE BE SURE TO PROVIDE FULL NAMES AND TELEPHONE NUMBERS WHERE REQUESTED. WE ARE ALL VOLUNTEERS, AND MOST OF US HOLD FULL-TIME JOBS. WE ARE NOT PAID FOR OUR RESCUE WORK, SO PLEASE BE PATIENT WHILE YOUR APPLICATION IS BEING PROCESSED. WE REQUEST THAT YOU CHECK ON THE STATUS OF YOUR APPLICATION BY EMAIL ONLY. THANK YOU. BOSTON TERRIER RESCUE RESERVES THE RIGHT TO REFUSE OR DISAPPROVE ANY APPLICATION BASED ON NATIONAL GUIDELINES. PRIORITY MAY BE GIVEN TO LOCAL ADOPTERS, OR THOSE ADOPTERS WHO PICK UP THE RESCUE IN PERSON, TO ALLEVIATE AS MUCH TRAUMA TO THE RESCUE AS POSSIBLE.

As a potential adopter, I do hereby certify that all of the information contained in this application is true and complete. I understand that if any of the information is inaccurate or incomplete, my application will not be processed. I further understand and agree that if chosen as an adoptive home, I will comply with 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 microchip). BOSTON will be kept under control at all times when off ADOPTER'S property.
2. ADOPTER shall keep BOSTON on heartworm preventative at all times for the rest of the BOSTON’s life, and shall provide adequate veterinary 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 sick or injured, or othewise requiring medical attention. If ADOPTER is unable to do so, ADOPTER will notify BT rescue IMMEDIATELY.
3. ADOPTER agrees to notify BT rescue contact of any change in address or telephone of adopter.
4. If BOSTON is lost or stolen, ADOPTER will immediately notify BTRGH contact.
5. ADOPTER shall return BOSTON to BTRGH, 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 BTRGH.
6. ADOPTER REPRESENTS THAT NO MEMBER OF HOUSEHOLD HAS EVER BEEN CHARGED WITH CRUELTY TO ANIMALS.
7. ADOPTER shall indemnify and hold harmless BTRGH and its members from any and all loss, damage, or expense. BTRGH does not warrant the temperament or behavior of BOSTON. BTRGH does not warrant the health of BOSTON, but does provide all medical records available. BTRGH is not liable for acts of BOSTON after placement with adopter.
Signatures of all adults residing in household: (please note by typing your name(s), this is the same as your written signature(s)) *
By clicking this check box, you agree that all of the information above is is deemed reliable and honest.
I Agree

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