First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone
x

Cell Phone

Dog's Name:

Please provide pictures of your dog to os@texasbostons.com

Gender:

Is your dog a purebred Boston Terrier, French Bulldog, or a mix? If mixed, what is it mixed with (please guess if unsure)?*

Is your dog spayed/neutered?

If answer above is no, please explain

Weight:*

What is your dogs Age/DOB:*

Is your dog house trained*
Choose one: Yes No

What color is your dog:

Reason for Surrendering (check all that apply):

If your answer above was Other or Behavioral issues, please describe

Are you the legal owner of the Boston?*

If you are not the Legal Owner, please explain:

Have you been the continuous owner of this dog?

Does you dog have any special health/physical problems? On any medication? Why?*

Do you have a regular veterinarian? If so, please list name, phone number and complete address for the veterinarian/clinic. *

Last visit to the vet?*

Is the dog up to date on vaccinations?

Has this dog been on heartworm preventative?

What kind of preventative and when was it given last?*

Vet Records available?

Please provide any medical records you have to os@texasbostons.com.

Is your dog kept inside or outside?

Can this dog be trusted stay in the house uncrated when no one is home?

Does your dog like (Check all that apply):

Has your dog ever bitten or attempted to bite a human being?*
Choose one: Yes No Unknown

If Yes, please explain the circumstances.*

Is your dog aggressive towards cats?*
Choose one: Yes No Unknown

Has your dog ever bitten or attempted to bite another animal?*
Choose one: Yes No

Is your dog aggressive towards other dogs?*
Choose one: Yes No Unknown

Has your dog ever attacked another animal?*
Choose one: Yes No

Has your dog ever bitten another dog?*
Choose one: Yes No Unknown

Does your dog do any of the following (Check all that apply):

How would you describe this dog (Check all that apply):

Other:

We can take the dog into rescue much more quickly if you are able to provide some transportation assistance. Are you able and willing to help by meeting our volunteer part of the way? *

We will work quickly to take your dog into foster care but your flexibility is greatly appreciated. Please indicate how urgently you need to place the dog in foster care. Your response to the item below is only a guide that will help us prioritize your needs. Please remember we use Volunteer foster homes and how quickly placement into rescue is based on availability of an open Foster home at the time of your request. Pure bred Boston Terriers will take priority over French Bulldogs and/or mixes because the majority of our adopters want a pure bred Boston Terrier when they come to us. When our foster homes are full, the wait time for a mix could be 60-90 days.*

If you are able to help with transport, how far are you willing to travel?*

I, "signature below", release and surrender of my free will the described dog, and hereby make available for adoption or any other disposition of the animal named "above", to Boston Terrier Rescue of North Texas, Inc. I certify that I am the owner of this animal, free and clear of all other interests. I certify that this animal is not possessed of any dangerous or vicious propensities. The information I have provided about this animal is true and complete to the best of my knowledge. I, hereby and forever release, discharge and agree to hold harmless and indemnify The Boston Terrier Rescue of North Texas, its Board of Directors, Leaders, Officers and Agents from all claims, demands, actions, causes of action or liability of any kind whatsoever arising as a result of or in connection with the adoption or any disposition of the above name animal. I understand that the BTRNT, Inc. Rescue shall not be held liable in any manner for their actions in the disposition of the above described animal, and that I relinquish all claims to the above described animal. I understand that Boston Terrier Rescue of North Texas provides a service to help place a pet in a new home when the present owner can no longer keep the animal for whatever reason. This service is free; however a donation to help pay for vetting and other expenses is always appreciated. In order to help defray any expenses incurred by the BTRNT, Inc., a non-profit organization, for the animal and to help in their efforts to rescue other Boston Terriers. (Your generosity is greatly needed and appreciated.) I also agree my name and phone number may be released to the new owner of this animal and that the new owner may contact me if she/he wishes to gain further information about this animal. Signature (Owner's Name):*