Nebraska Boston Terrier Rescue

Adoption Application

Thank you for your interest in NBTR's rescue dogs.  Completing this application is merely the first step in adopting a Boston Terrier.  We would appreciate your honest answers to the following questions so we can select the appropriate dog for you.  By submitting this completed application, you are neither guaranteed nor obligated to adopt a dog.  This is merely the beginning of a process that will include a vet reference, phone interview and a home visit.  Once we have received your application and it has been reviewed and accepted for further processing a volunteer will contact you to schedule the required home visit.  Please understand that we do this rescue work on a volunteer basis and we will get to your application as soon as possible.  You will not be contacted unless we think we have a match for you.  Applications are reviewed in the order they are submitted.  A dog may be perfect for you, but someone else may have submitted an application first.  If they first application falls through (and it does happen) I will move on to the next application in line.  If  you want to check and make sure your application was received you may email Jenjen25@aol.com to check. 

NBTR usually only adopts to Nebraska, Iowa, Kansas, Missouri, Colorado, Minnesota, South Dakota and Wyoming.  Other states will be considered if you are willing to travel to get your new family member.

NBTR requires a fenced-in area for each adoption.

PRESS THE "TAB" BUTTON TO MOVE BETWEEN FIELDS ON THIS APPLICATION. DO NOT HIT THE "ENTER" BUTTON OR YOU WILL SUBMIT YOUR APPLICATION.

First Name   Last Name

     Spouse's Name (if applicable)

Occupation(s)

E-Mail Address

Street Address   City   State ?? Zip Code

Home Phone     Work Phone      Cell Phone(s)

Best time to call

How long have you lived at your present address?

Do you rent or own your home   Rent   Own
   *Please note that renters must include documentation from the landlord that dogs are allowed to live in this dwelling.

What style is your home: Ranch  Two Story   Other

If you move, what will you do with this dog?

Where will the dog be kept.....
      While at work?
      At Bedtime?
      While no one is home?
      While on vacation?

On average how long will this dog be left alone each day?

Exercise/Elimination for this dog will be: Doggie Door Totally Fenced in Area Future plans for fenced area
*Nebraska Boston Terrier Rescue requires a totally fenced-in area for ALL adopted dogs. This requirement is for the safety and well being of the dogs. Boston Terriers are generally indoor dogs, however, due to their activity level they still require freedom outdoors without a leash. If you do not currently have a fenced-in area, but are planning to install one in the near future, please continue to complete and submit this application. If there are no plans for a fence you will not qualify.

Choose the type of fence you have: Wood   Plastic   Chain Link

Choose the height of your fence: 4 foot  5 foot  6 foot

Does anyone in the family have allergies to dogs? Yes  No

Who will be responsible for this dog?

Please provide the name contact information of your veterinarian, or the one you will use with this dog?
     Vet Clinic Name
     Veterinarian's Name
     Clinic Address?
     Clinic Phone Number

Please list two other references we may contact regarding this adoption:
     Reference #1.
     Name?
     Phone Number?

        Reference #2.
     Name?
     Phone Number?

Please list all types of pets (Dogs, Cats, Gerbils, etc.) including breed , age and gender that currently live in this household:
   Type                 Breed              Gender              Age          Spay or Neuter
                 
                 
                 
                 
                 

If any of your pets are NOT spayed of neutered, please explain why:
NBTR promotes spaying and neutering? to prevent pet overpopulation and unwanted pets.

If you have lost a pet or it died at an early age or due to an accident, please provide details:

If you have ever given up a pet or put one to sleep, please provide details:

If you have ever surrendered a pet to a shelter or rescue group, please provide details:

How much money do you plan on spending on this dog each year? (food, toys, vet costs, boarding, grooming, etc.)

Describe you reason for wanting to adopt a Boston Terrier:

Would you be willing to adopt a dog with some health problems? Yes No

Would you be willing to adopt a dog that is not housebroken? Yes No

Would you be willing to adopt a dog with some behavior problems? Yes No

Explain the size, sex and personality of the dog you prefer to adopt?

What age range would you consider adopting?

Would you consider a Boston Terrier MIX? Yes? No

List ALL members in your household (including yourself):
    Name                   Age                 Relation
           
           
           
           
           
           

Are there plans for children in the future?  Yes  No

How many children VISIT your home and what are their ages? 

Have you applied with any other rescue organizations? Yes No  If yes, which ones? ?                                                        If yes, has a home visit been completed?? Yes? No

How did you hear about Nebraska Boston Terrier Rescue?

Which dog(s) on our website would you like to learn more about?

Would you be willing to drive and meet to pick up your new dog? Yes No

COMMENTS:

By submitting this form you are declaring that all information contained above is true and correct.  Any false information will disqualify you from adopting a Boston Terrier from Nebraska Boston Terrier Rescue.  You are confirming that you are over 18 years of age and the person responsible for making pet decisions in your family.  You are stating that you are seeking to adopt a dog, give it a good and loving home and accept full responsibility for his/her care.

I agree to abide by all state and local animal control and leash laws.  I understand it is my responsibility to become familiar with these laws.

By submitting this application I certify that all the above information is correct and I give permission to contact the references listed above.

 We will only email you if we have a dog that matches your application.  If you want to make sure that your application was received or check on the status of your application then please email Jenjen25@aol.com to check.

 Updated June 2008