First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Cell Phone*

Alt Email

Please let us know which dog(s) you are interested in:*

Gender*

Do you*

Type of Dwelling*
Choose one: House Apartment Condo

Type of Yard*
Choose one: Unfenced Chain Link Wooden No Yard

If renting, please provide your landlord's contact information

If you own, are you a part of a homeowner's association?

If you are part of a homeowner's association, please provide a brief explanation of the by-laws pertaining to dogs

Name, gender and age of all family/household members*

Do any members of your family/household have allergies to dogs?*

Have any members of your family/household been charged with cruelty or neglect to animals?*

Have you applied with any other rescue group?*

If so, which groups and when?

Please provide the name, relationship and phone number for three personal references

Personal Reference 1:*

Personal Reference 2*

Personal Reference 3

Please provide your Veterinarian's name, clinic name and phone number*

If you use more than one Veterinarian, please provide their details as well

Please list all animals with ages currently living in your home*

If you currently have animals, are they up to date on vaccinations?

If you currently have dogs, are they up to date on heart worm preventative?

Please list all animals you have had in the last 10 years and what happened to them (if alive and if not, how they passed away)*

Describe your ideal dog*

How much do you anticipate to be the yearly cost of owning a Boston Terrier (including but not limited to food, supplies and vet care)?

Have you owned a Boston Terrier before?*

List plans for the dog (family member, pet, guard dog, obedience, agility, other)*

Age Preference (select all that apply)

What issues are you willing to work with?

Are you willing to housetrain your Boston Terrier?*

Do you plan to take your Boston Terrier to obedience classes?*

What health issues or disabilities are you willing to work with? (select all that apply)

Do you want your Boston Terrier to be... (select all that apply)

What privileges will your Boston Terrier have? (select all that apply)

Where will your Boston Terrier sleep at night?*

How many hours per day will your Boston Terrier be home alone?*
Choose one: 0 - 3 4 - 6 7 - 9 10+

Where will your Boston Terrier spend their alone time?*

What brand of food do you intend to feed your Boston Terrier?*

Do you have time to exercise your Boston Terrier?*

Additional comments and/or special circumstances ABTRR should be aware of (if none, please enter "N/A")*

I understand that: ABTRR reserves the right to refuse any application for any reason. ABTRR reserves the right to suggest and place in your home a different dog than the one you indicated above, based on your answers to the questions on the application below. Incomplete applications will not be processed. If I’m residing in a rental or condominium/co-op, or a house that is a part of a homeowner's association, prior to adoption, I will need to provide a copy of the bylaws, rules and regulations of such association stating that there are no restrictions regarding owning a dog. If there is a limit on the number of pets allowed, please note the limit on the copy of the by-laws. If my application is approved, ABTRR will require a NON-REFUNDABLE adoption donation of $350 for adult dogs or $450 for puppies 9 months and under to help defray the ever increasing costs of veterinary care for the rescued dogs. ABTRR will adopt some of our dogs out of state, depending on their situation and needs; however, it is our policy not to ship dogs. Adopters may fly to Dallas, TX to adopt the dog, or they may fly them in-cabin on an airplane (via an airline who accepts Boston Terriers in the cabin). All transport costs are at my (the adopter's) expense. I will pay all transportation costs for returning the dog to ABTRR, should it be necessary for ANY reason. ABTRR derives its only source of funding through donations and fund-raising activities. The adoption donation for this animal is considered NON-REFUNDABLE, even if the dog is returned to the rescue at ANY time. ABTRR does not knowingly misrepresent any animal's age, condition of health, or temperament. ABTR is only a referral service and therefore is in no way liable or responsible for any damage, injury, or accident resulting from the placement of any dog into my household. There is no health warranty given with the dog. If he develops an illness or injury after adoption or is discovered to have an illness not discovered before adoption, I am responsible for treating that illness/injury, even if it is discovered the day after adoption.*

I certify that: if selected and I adopt a dog from ABTRR, I MUST comply with the following: I will not allow the dog to ride in the open bed of a pickup or any other open type of vehicle the dog can jump or be thrown from. I will not use said dog for fighting bait, hunting, guard duty or animal research. I will closely supervise said dog when around ANY body of water, Boston Terriers are not good swimmers and have a high risk of drowning. my Boston Terrier will never be left in a parked vehicle unsupervised.*

I agree that: if I am unable to care for or keep the dog for any reason, I will return the dog to a designated officer, agent or representative of ABTRR. in no event will the dog be sold or given away by me (or any member of my family) to another person or placed in an animal shelter or humane society or turned loose to roam freely. Boston Terriers are sensitive to extreme temperatures, both hot and cold, and therefore are primarily indoor dogs. I will exercise proper control and restraint over the dog at all times and will not allow the dog to run at large. I agree to have a collar and identification tags on the dog at all times even if my pet stays indoors. in the event of my death my next of kin will notify ABTRR immediately allowing ABTRR to take possession of said dog. I am to make next of kin aware of this clause in the contract. In the event that a family member/ friend wants to adopt said dog, no adoption fee will be charged but the new adopters must submit to the same screening process that I have submitted to. It is strongly recommended by ABTRR that these provisions be made as soon after the adoption as possible in order to have this paperwork in your adoption file. If no provisions have been made or if the provisions are not acceptable by ABTRR guardianship will revert back to ABTRR. the dog will NEVER be used for breeding or experimentation purposes. I will notify ABTRR if the dog is ever lost, stolen or deceased. I will closely supervise my or any other child while interacting with the dog and should a bite occur, ABTRR is not responsible/liable in any way for this happening. ABTRR is very adamant that ANY interaction between our rescue dogs and all children be closely supervised. Unfortunately, there are many children who have not been taught to interact well with dogs and a dog’s only means of defense is to bite. I will properly house, feed, water, exercise, care for and provide inoculations, heart worm prevention and other veterinary or supportive care as the dog requires for the remainder of his lifetime, which includes giving heart worm preventative every month for the rest of his life. in the event the Transferee(s) breaches any covenant or condition herein and incurs any legal costs, including any attorney's fees, costs of litigation, including costs of deposition, witness fees for expert or non expert witnesses, or court costs, or any other expense in relation to the enforcement of any covenant or condition, the transferee(s) shall be individually and jointly liable therefore to ABTRR. I agree that I will allow representatives of ABTRR to check the dog and its environment, and that if at any time the placement is found to be detrimental to the dog's health, mental or physical well-being, ABTRR reserves the right to remove the dog from said placement until the situation is corrected or until another placement can be made. It is agreed that ABTRR shall retain Superior title of said animal, and may exercise its superior claim if at any time the conditions of this agreement are not being met. This claim is limited to and for the express purpose of assuring the animal's well-being and only to exercise its superior claim in the event it appears to ABTRR that the proper and humane care, as specified in the adoption provisions in this and the adoption contract, is not being afforded said animal, in which case the animal may be taken through a claim and delivery proceeding. The adopter further agrees that if there is any breach or default of the terms of this contract, and the dog must be redeemed through a claim and delivery service, that the adopter will be held liable for all court costs and fees for the adopter’s attorney and for the rescuer’s attorney. In the event any term(s) of this contract is breached by the adopter, the adopter shall pay to American Boston Terrier Rescue the amount of $1,000 USD ($1000.00) as liquidated damages for said breach. THE ADOPTER AGREES THAT AMERICAN BOSTON TERRIER RESCUE & REHABILITATION HAS THE RIGHT TO ENTER UPON HIS/HER PROPERTY, WITHOUT NOTICE TO REPOSSESS THE ANIMAL IF ANY TERM OF THIS CONTRACT IS DEEMED BREACHED BY AMERICAN BOSTON TERRIER RESCUE. THE ADOPTER THEREBY FORFEITS ALL RIGHTS OF OWNERSHIP OF ADOPTED DOG UPON BREACH OF THIS CONTRACT. I have read this agreement, understand and agree to abide and by checking this box am electronically signing this contract voluntarily.*

By entering your name and date below, you are electronically signing this document.*

Don't forget to click "Submit" below!