Adoption Application

Wisconsin Boston Terrier Rescue Adoption Application
Name*

First NameLast Name
Today's Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Main/Daytime Phone Number*

Area CodePhone Number
Evening/Other Phone Number

Area CodePhone Number
Best time to call*

DaytimeEveningWeekendPrefer text messages
E-mail address*
You must provide an email address, and it should be one you check regularly. WBTR contacts people by email and may not have time to call you if you do not respond to e-mail.
Which dog are you interested in adopting?
If there is not a specific dog you are interested in, we will keep your application on file, but you will need to email wbtradoption@gmail.com and tell us when you are interested in a specific dog. We cannot notify you of new available dogs.
Will this be your first dog?*

YesNo
For what reason(s) are you wanting to adopt this dog? (check all that apply)*

Companionship for meCompanionship for other petHouse petGiftWatch dogGuard dogCompetition dogBreedingOther
If "other", please explain:
How long have you been at your present address?*
Do you rent or own your home*

OwnRent
* Renters will be asked to email a copy of your lease or written signed statement from their landlord stating that a pet of this size is permitted.

* Proof of ownership/purchasing may be requested.
Will you agree to a home check prior to approval?*

YesNo
If no, please explain:
If you move, what will you do with your adopted Rescue?*
How many adults live in your household?*
What are their ages?*
Occupation(s):*
How many children live in your household?*
What are their ages?
Will children be visiting?*

YesNo
If there are no children in the home now, do you plan on having children in the future?*

YesNo
Who will be responsible for the care of this animal?*
Where will the dog be kept during the day?*
Where will the dog be kept at night?*
Where will the dog be kept when no one is at home?*
How long will the dog be left alone each day?*
Exercise and elimination will be: (check all that apply)*

Exercise pen or runOn leashOn chain or trolleyTotally enclosed fenced yard at homeFenced yard at a location other than home (dog park, friend or family member's house)Partially enclosed fenced yardElectronic/Radio fenceLoose in un-fenced yardIndoor area (papers, etc)
Are there any health issues in your family that would prevent you from properly taking care of this dog?*

YesNo
How would you correct a dog that has done something wrong?*
What would you do if your dog broke something of value of yours?*
Any prior training or obedience class experience? (please explain)
Please list all pets you currently own or have owned in the past five years:
Animal #1 Type
Name
Breed
Age
Gender
Spayed/Neutered?

YesNo
Where is this animal now?
Animal #2 Type
Name
Breed
Age
Gender
Spayed/Neutered?

YesNo
Where is this animal now?
Animal #3 Type
Name
Breed
Age
Gender
Spayed/Neutered?

YesNo
Where is this animal now?
If you currently have more than three pets, please list the species, name, sex, age, and spay/neuter status of the other pets in your home here:
Were any of your current or former dogs adopted from Wisconsin Boston Terrier Rescue?

YesNoI have never had a dog.
Does your city, town, or village restrict how many additional pets can reside at your home? (This may be a limit on dogs or on a combination of dogs and cats.)

Not applicable: no current current pets or only have one and can definitely have anotherNo limits on number of pets at homeWill be within restrictions even after adopting another dog (Please describe limits or rescritions below)Limits or restrictions unknown (Please note application review may be delayed while volunteers check)At limit, but have or will apply for permit or exception (Please describe below; documentation will be required)
Description of any pet limits where you live or any permit or exception you have or will apply for:
Have you ever surrendered a pet up to a shelter or rescue?*

YesNo
If yes, please explain the circumstances:
If you have ever had a pet lost or die at an early age or because of an accident, please explain:
How much do you expect to spend on this animal each year?: (Include food, vet care, boarding, licensing, grooming, etc)*
Will you consider a Boston Terrier rescue dog that has behavioral problems?*

YesNoMaybe
If yes or maybe, please check off behaviors below that you would accept in a rescue dog:

Not housebrokenLikes to digBarksJumps up on peopleNot leash trainedHas separation anxietyNipsChews
Would you consider a Boston Terrier rescue dog with health problems?*

YesNoMaybe
If yes or maybe, please check off health problems that you would accept in a rescue dog.

AllergiesDeafBlind3 legsLimpsOn meds
Do you prefer a male or female?*

MaleFemaleDoesn't matter
Desired age (check all that apply)*

Puppy (<1 yr)Under 3 yearsUnder 6 years7 +SeniorDoesn't matter
Would you consider a mix or breed other than a Boston Terrier?*

YesNoMaybe
Is appearance or size important?*

YesNo
If yes, please explain:
Do you agree to return this dog to Wisconsin Boston Terrier Rescue if you are unable to care for it for any reason?*

YesNo
Name of veterinarian or veterinary clinic:*
Phone number of veterinarian or veterinary clinic:*
Some vet clinics require your permission to answer our volunteers' questions. If your vet needs your permission to give our volunteers any information, please call them and tell them it is ok to answer questions for WBTR volunteers.
Reference Information

Please list two references we may contact regarding this adoption application. If possible, these should not be your parent, spouse, or significant other. Close friends or extended family who have known you for a long time may be good choices.
Reference #1 Name*
Reference #1 Relationship*
Reference #1 Phone Number*
Best time to call?*
Reference #2 Name*
Reference #2 Relationship*
Reference #2 Phone Number*
Best time to call?*
Is there anything else you would like to share with us regarding your application?
THE RECIPIENT BOSTON TERRIER RESCUE GROUP OR PERSON RESERVES THE RIGHT TO REFUSE ANY APPLICATION

By filling and electronically submitting I/We certify that all of the information on this application is true and complete. I/We understand that if selected as an adoptive home I/We will comply with the following conditions of adoption:

I. ADOPTER shall keep ADOPTED BOSTON as an indoor pet and will provide BOSTON with identification at all times (i.e., collar tag, tattoo, or microchip). BOSTON will be kept under control at all times when off ADOPTERS property.

II. ADOPTER shall provide adequate veterinary care for BOSTON, including annual vaccinations, rabies vaccinations as needed, and any other care recommended by BOSTONS veterinarian. ADOPTER will take BOSTON to the veterinarian if ill. If ADOPTER is unable to do so, ADOPTER will notify BOSTON TERRIER RESCUE contact.

III. ADOPTER agrees to notify BOSTON TERRIER RESCUE contact of any change of address or telephone number of ADOPTER.

IV. If BOSTON is lost or stolen, ADOPTER will immediately notify BOSTON TERRIER RESCUE contact.

V. ADOPTER shall return BOSTON to BOSTON TERRIER RESCUE if, under any circumstances, ADOPTER is no longer able to keep or provide for BOSTON. ADOPTER shall not sell, give or otherwise transfer or convey BOSTON to anyone other than BOSTON TERRIER RESCUE.
E-mail
example@example.com
If you have questions about the adoption process, please see the Adoption section of our website at www.wisconsinbostonterrierrescue.com, including Frequently Asked Questions. If you have additional questions or would like to check on the status of your application, please email wbtradoption@gmail.com
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Wisconsin Boston Terrier Rescue Adoption Application

Reference Information