ADOPTION APPLICATION

The person or persons submitting this application will henceforth be known as the ADOPTER. The potential Rescue Boston Terrier will be known

henceforth as the BOSTON or the ADOPTED BOSTON. The Rescue Group or Rescue Person where this adoption application is submitted will be

known henceforth as OREGON BOSTON TERRIER RESCUE and the ADOPTER must take full responsibility to insure that arrangements are made

with OREGON BOSTON TERRIER RESCUE if a situation arises where the BOSTON can no longer be cared for by the ADOPTER as stated below.

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?: _____________________________________

Occupation: _____________________________________

Where will the pet be kept during the day?: __________________________ 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?: _____

Indoor Area (Papers, etc.)?: ______ Partially Fenced Area?: _____ Electronic/Radio Fence?: _____

Loose in Unfenced Yard?: _____ Totally Enclosed Fenced Yard?: _____

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: ________________ Age: ____ Gender: ____ Spayed/Neutered?:___ Where is it now?:________

(Dog, Cat, Breed)

#2. Type: ________________ Age: ____ Gender: ____ Spayed/Neutered?:___ Where is it now?:________

(Dog, Cat, Breed)

#3. Type: ________________ Age: ____ Gender: ____ Spayed/Neutered?:___ Where is it now?:________

(Dog, Cat, Breed)

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 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 of Veterinarian: ____________________________________ Phone: __________________

Address: ______________________________________________ Email: ___________________

Please list two other references we may contact regarding this adoption:

#1. Name: _________________ Relationship: _________________ Phone: __________________

Email: _____________________________ Address: ____________________________________

#2. Name: _________________ Relationship: _________________ Phone: __________________

Email: _____________________________ Address: ____________________________________

*OREGON BOSTON TERRIER RESCUE GROUP OR THEIR REPRESENTATIVE

RESERVES THE RIGHT TO REFUSE ANY APPLICATION*

By filling, signing and 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, with outdoor privileges, 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, on leash or in a crate, when off ADOPTER’S property.

II. ADOPTER shall provide adequate veterinary care for BOSTON, including annual vaccinations, rabies vaccinations as needed, and any other

care recommended by BOSTON’S veterinarian. ADOPTER will take BOSTON to the veterinarian if ill. If ADOPTER is unable to do so, ADOPTER

will notify OREGON BOSTON TERRIER RESCUE contact.

III. ADOPTER agrees to notify OREGON 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 OREGON BOSTON TERRIER RESCUE contact.

V. ADOPTER shall return BOSTON to OREGON BOSTON TERRIER RESCUE if, under any circumstances, ADOPTER is no longer able to keep

or provide for BOSTON. ADOPTER shall not sell, give, otherwise transfer, or convey BOSTON to anyone other than OREGON BOSTON

TERRIER RESCUE.

VI. If unaltered at time of adoption, ADOPTER shall have BOSTON spayed/neutered within 30 days of adoption date and have veterinarian fax

or send confirmation of procedure per Spay/Neuter Agreement signed on this date.

VII. ADOPTER agrees that I/we will allow representatives of Oregon Boston Terrier Rescue to check the dog and its environment, unannounced

at any time. That if at any time, the placement is found to be detrimental to the dog's health, mental or physical well-being, Oregon Boston Terrier

Rescue reserves the right to remove the dog from said placement until the situation is corrected OR until another placement can be made, without

refunding adoption fees.

VIII. ADOPTER agrees to RELEASE OF LIABILITY AND INDEMNITY: I/we promise and agree to be solely responsible for the DOG. To

indemnify and hold harmless Oregon Boston Terrier Rescue, their agents and representatives, members, successors or assigns from any and all

claims of liability. This includes all liability and indemnity for any conduct, behavior, damage or injury caused by the dog to any person or property;

from any claim or damages known or unanticipated resulting from any claim or damages arising by my/our ownership or control thereof. Oregon

Boston Terrier Rescue is not liable for acts of BOSTON after placement with adopter.

IX. ADOPTER understands that 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, the adopter is responsible for treating that illness/injury.

IX. ADOPTER also understands that Oregon Boston Terrier Rescue 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.

X. ADOPTER understands that, 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

Oregon Boston Terrier Rescue.

XII. ADOPTER REPRESENTS THAT NO MEMBER OF HOUSEHOLD HAS EVER BEEN CHARGED WITH CRUELTY TO ANIMALS.

XIII. ADOPTER certifies that all of the above information is accurate and complete. I/we understand that if selected and adopting a Boston

terrier (the "dog/animal") from Oregon Boston Terrier Rescue, I/we must comply with the above stipulations or forfeit dog back to Oregon Boston

Terrier Rescue without refund of adoption fees.

I hereby certify that I have read the above Adoption Application Contract, fully understand all that I have read, and I agree to each and every

outlined term and condition for the adoption of the dog. Initial ______

Signature of Applicants Residing in Household Date

#1. _______________________________________ ____________________

#2. _______________________________________ _____________________

#3. _______________________________________ _____________________

Signature of Boston Terrier Rescue Date Received

__________________________________________ _____________________

Witness: ___________________________________ _____________________

Witness: ___________________________________ _____________________

"Dedicated To Helping As Many Rescue Boston Terriers As We Can"

*OREGON BOSTON TERRIER RESCUE RESERVES THE RIGHT TO REFUSE
 ANY APPLICATION FOR ANY REASON* 
The answers you give on this application will help us find the best possible match between you 
and the dogs available for adoption. Remember we are searching for the perfect home for each 
individual dog. You may have a perfect home for one dog, but not another. 
This is not an over night process, we are volunteers and don’t always have available dogs, so 
please expect some waiting time to be involved. Please answer all questions as completely as 
possible. If any information is omitted, the application will be discarded. 
We reserve the right to inspect the prospective home environment both before and after adoption 
without any advanced notice. In addition, if we discover that any information on this form was 
knowingly falsified, we reserve the right to take the dog back into our possession. 
PLEASE NOTE: If your application is approved, we will require a donation, at time of adoption, 
of up to $250 to defray the ever-increasing costs of veterinary care for our rescued dogs. 
In addition, at time of adoption, you will be required to sign a contract committing to the 
care of the dog.

…………………………………………………………………………………………………………………

( for Oregon Boston Terrier Rescue Only)

Mail to: OBTR, C/O Wanda Bailie, 2777 S. Cherry St., Cornelius, OR 97113

Or email to: w_bailie@yahoo.com

Adoption approval by:_______________________________ Date: ______________

Boston Terrier Adopted:______________________________ Date: ______________

Standard adoption fee is $250.00 for altered dog and $200.00 for unaltered dog, due at time of adoption. Adoption contract must also be signed

at time of adoption. This cost may increase depending on amount of veterinary care provided to get dog into healthy condition. Any unaltered

dogs MUST be altered at new owners expense within 30 days or dog will be repossessed without refunding adoption fees. Adopting unaltered

dogs are a rare exception and a legal contract to spay/neuter must be signed at time of adoption in addition to adoption contract. Verification of

spay/neuter must come from vet letter or receipt from vet.