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PLEASE read Adopting a puppymill dog! Prior to filling out the application! Thank you!

Please copy and paste and email to beve@rainbowtel.net - or fax it to 785-742-3913 after 4:30 pm PST

click here to download application

CONTACT INFORMATION
Name:
Street Address:
City:
State/Province:
Country:
Zip/Postal Code:

Ph - Day:
Ph - Eve:
Best Time To Call:

E-mail Address:

ADOPTION INFORMATION

How long have you been at your present address?:
Do you own or rent?:

* Renters must attach a copy of your lease or notarized statement from your landlord stating that a pet of this size is permitted.

If you move, what will you do with your adopted Rescue?:

Will you agree to a home check prior to approval?
If no, explain:


Occupation:

Where will the pet be kept during the day?:

Where will the pet be kept at night?:

Where will the pet be kept when no one is at home?:

How long will the pet be left alone each day?:

How many adults live in your household?:
What are their ages?:
How many children?:
What are their ages?:
Will there be children visiting?:

Who will be responsible for caring for this animal?:

Exercise and elimination will be:
(Check all that apply)
In Exercise Pen or Run?:
On Lead?:
On Chain or Trolley?:
Totally Enclosed Fenced Yard?:
Partially Fenced Area?:
Electronic/Radio Fence?:
Loose in Unfenced Yard?:
Indoor Area (Papers, etc.)?:

Please list all pets you currently own or have owned in the past five years:
(If none, include pets owned during your adult life)

#1.
Type:
(Dog, Cat, Breed)
Age:
Gender
Spayed/Neutered?:
Where is it Now?:

#2.
Type:
(Dog, Cat, Breed)
Age:
Gender:
Spayed/Neutered?:
Where is it Now?:

#3.
Type:
(Dog, Cat, Breed)
Age:
Gender:
Spayed/Neutered?:
Where is it Now?:

If you have ever had a pet lost or die at an early age or because of an accident, please give details:


Have you ever given a pet up?:
If yes, please explain the circumstances:


How much do you expect to spend on this animal each year?:
(Include food, vet care, boarding, licensing, grooming, etc)

Do you prefer a Male or Female?:
Does the sex of the rescue matter?:

Desired Age?:
Would you consider a dog more than 3 years of age?:
More than 6 years of age?:
More than 10 years of age?:

Will you consider a dog that is not housebroken?:
Has health problems?:

Is appearance or size important?:
If yes, please explain:

Do you agree to return this dog to Boston Terrier Rescue if you are unable to keep it for any reason?:

REFERENCE INFORMATION

Name and phone of Veterinarian:

Please list two other references we may contact regarding this adoption:
#1.
Name:
Relationship:
Phone:
Best Time to Call?:

#2.
Name:
Relationship:
Phone:

Best Time to Call?: