BOSTON TERRIER RESCUE CANADA

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1 BOSTON TERRIER RESCUE CANADA Adoption Application How did you hear of Boston Terrier Rescue Canada (BTRC)? Date: Every BTRC rescue dog is vet examined, vaccinated, parasite tested and treated as required, spay/neutered, microchipped, and has received any necessary additional medical care. Our standard adoption donation is $400.00, with some exceptions for puppies, senior or special needs dogs. Our adoption application is the first step in our adoption process, but does not guarantee a prospective adopter a rescued dog. We work to match our dogs' personalities and requirements with your experience level and lifestyle. Name: Address: City/Town: Province: Postal Code: Home Phone: Best Number to Call? Employer: Cell Phone: Best Time to Call? Occupation: Work Phone: Please list full name of all other adults residing in the household and their relationship to applicant: How long have you lived at your present address? If less than 6 months, please provide previous address: Do you own or rent your home? *Please note that renters must include documentation that dogs this size are allowed to live in this dwelling or must list the landlord s name and telephone number below so that we may contact them. Landlord s Name: Phone: If you move, what will you do with this dog? Where will this dog be kept: (please be as specific as possible; i.e. run of the house, a specific room, a crate, etc.) During the day? At night? When no one is home? What areas, if any, will be off-limits to the dog? page 1

2 Where will the dog stay when you are on vacation? How long, on average, will this dog be left alone each day? Exercise and elimination for this dog will be: (please select all that apply) On lead? Electronic or radio fence? On a chain or tie-out? Loose in the yard? (no containment) Fenced yard totally enclosed? Partially enclosed yard? Indoor litter box or paper trained? Other? Please explain: Do you have children? If so please list age and gender of each: Please list the ages of children that visit your home regularly: Who will be the dog s primary caregiver? Please provide the name, address, phone number, and length of time you have been with your current/last veterinarian: May we contact your current veterinarian as a reference? Please notify your veterinarian that an application has been submitted to adopt a rescued Boston Terrier, and give permission for your vet to release veterinary records and information about your pet care history to a BTRC representative. The only exception for not having a vet reference is an applicant that is applying for their first pet. Please provide two personal references that are not related to you that we may contact regarding this adoption, including telephone number, address and relationship to you. If you are unable to provide a veterinary reference, as a first time pet owner, please include a third personal reference. Reference #1: Reference #2: Reference #3: Have you, or any other person residing in your household, ever been investigated for or charged with any crime related to the treatment of or cruelty to animals? Please list dogs and cats that have lived in your household in the last 5 years that you no longer own: page 2

3 If you have lost a pet or if a pet died at an early age please provide details: Have you ever given up a pet or had one put to sleep? If yes, please explain why: Do you currently own dogs? If yes, please complete details below: Do your dogs get along with other dogs? (small, large, male/female): Do you currently own cats? If yes, please complete details below: Are your cats experienced around dogs? Do you have other animals? If yes, please describe the number and species of each animal. If any pets are NOT spayed or neutered, please give reason: Are your dogs/cats current on vaccinations? Do you test for heartworm every year & keep your pets on heartworm preventative medication? Type of preventative given? page 3

4 Pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, shelter and exercise for your new pet? How much do you expect to spend on this dog each year? (food, vet care, toys, boarding, etc.) How would you rate your level of dog owning experience? (First-time owner, beginner, intermediate, advanced, etc.?) Do you have any dog training experience? If so, please detail: If a behavioral problem arises, what steps will you take to work on it? Do you agree to return your adopted Boston Terrier to Boston Terrier Rescue Canada or their appointed agent if, for any reason, you are no longer able to keep or provide for your rescued Boston? Describe briefly the Boston Terrier that you would like to adopt: Preferred age: Preferred gender: Will you consider other matches? Are you willing to adopt a special needs dog? (By this we mean health issues such as blindness, deafness or a treatable medical condition.) Would you be willing to work with a dog that is not fully housetrained? Would you be willing to accept a dog with some behaviour problems? What behaviour problems would you consider unacceptable? Are the looks or size of Boston Terrier important to you? Any additional comments/questions: page 4

5 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 found to be inaccurate my application with not be processed. By submitting this application to Boston Terrier Rescue Canada (BTRC) I agree and consent to the collection, use and transfer of my personal information for the purposes of processing my application. BTRC may in the future use my address and/or address to keep me informed of activities including programs, services, special events and funding needs. I understand that I may opt-out from receiving this information at any time by notifying BTRC at the contact info listed at the bottom of this document. Signatures of all adults residing in the household: Signature: Date: Please return completed form via to By Fax to our Toll Free Fax Number: IMPORTANT INFORMATION Please be sure to complete this application entirely, leaving no blank areas. If a question does not apply, mark as N/A. Incomplete applications may not be processed. Once your adoption application is received you will receive an confirmation within 72 hours. If you do not hear back from us within this time frame please contact us again as it is likely we did not receive your application. Completing this adoption application is a pre-requisite to adopting a rescued Boston Terrier through BTRC. All successful applicants are selected based on the needs of our dogs. BTRC reserves the right to refuse or disallow any application. We receive more qualified applications from good homes than we have Boston Terriers to place, so we can not estimate how long you may wait for the right match. Adoption applications are kept on file for six (6) months or until we identify the right dog for you and your family. We understand applicants are often anxious to bring home their new companion, and may look for a dog from more than one source. If you acquire a dog before we have one available, please let us know so that we can put your application in our inactive file, saving our volunteers' time and your own. is our primary means of communication. Please add to your address book so our s to you do not go into your spam folder. Thank you for your support of Boston Terrier Rescue! page 5

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