First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Email*

Home Phone

Cell Phone*

Alt Email

Please list the first and last name of all adults (over 18) in the home:*

Please list the ages of all adults in the home:*

Please list all adults occupations:*

Do you currently have animals in the home?*

If applicable, Please list all animals, species, M/F and age

Please list ages of children in the home.

Will children be visiting?*
Choose one: Yes No

In what type of home do you live?*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

How long have you lived at your present address?*

Do you own or rent your home*
Choose one: Rent Own

If you rent, please enter your landlord's name and phone number: *We will need to verify acceptance of pets.

How much time will the dog spend alone?*

Where will the animal be kept when you are not home?*

Where will the animal be kept at night?*

What plans will be made for the dog when the family travels?*

What would you do with the dog if you had to move? What would you do if where you were moving would not accept dogs?*

Do you have a yard? If yes, please describe your yard. (Grass, Fence Type, Height, Rock/Gravel):

Do you have a pool?*
Choose one: No Fenced Unfenced

Have you ever housetrained a pet? Describe what you would do to prevent accidents in the home.*

Have you ever obedience trained a dog?*
Choose one: Yes No

How do you feel about crate training a pet?*
Choose one: Yes No

Have you ever lost or had to give away a pet?*
Choose one: Yes No

Are all animals in your home Spayed/Neutered? *We require that all animals be spayed/neutered in order to adopt.
Choose one: Yes No

Do animals in the home wear ID tags at all times?
Choose one: Yes No

Are all animals in the home microchipped and registered with UTD information?
Choose one: Yes No

Are all pets licensed in accordance with the laws of your county?
Choose one: Yes No

Are your animals well socialized with other dogs?
Choose one: Yes No

Boston Terriers are prone to allergies, eye injuries, cataracts and airway restrictions. If a costly emergency arose would you be prepared for the expense of treatment?*
Choose one: Yes No

Is gender important? If so please list preferred gender.*

What age range do you prefer? (This does not guarantee the desired age will be available if you are approved.)*

Is size or appearance important?*

Have you ever owned a Boston Terrier?*
Choose one: Yes No

Why are you interested in adopting a Boston Terrier?*

What traits are you looking for in a pet

Have you applied with any other rescue*
Choose one: Yes No

May we contact your veterinarian?*

Veterinarian's Name and Phone Number*

Please list the first, last and phone number of at least one reference (who is not a family member, for example animal trainer, groomer, dog walker, etc)*

I certify that all information contained in this application is true and complete. I understand that if chosen as an adoptive home, I will comply with the following conditions of adoption: • Adopter will keep the dog as an indoor pet. • Adopter will keep the dog identified at all times with current tag and microchip contact information. • Adopter will provide adequate veterinary care, including vaccinations as needed and any other reasonable care recommended by the veterinarian. • Adopter will take the dog to the vet if ill or injured. • Adopter will immediately notify AZBTR if dog is lost or stolen. • Adopter will not sell, give, or otherwise transfer dog to anyone other than AZBTR. • Adopter represents that no member of household has ever been charged with a misdemeanor or felony involving neglect or cruelty to humans or animals. • Adopter will indemnify and hold harmless Arizona Boston Terrier Rescue, Inc. and its members from any loss, damage, or expense. AZBTR does not warrant the temperament or behavior of the dog. AZBTR is not liable for acts of the dog after placement with the adopter. *