Midwest Boston Terrier Rescue Adoption Application
Please complete this form to apply to adopt a dog.

Please note: a $20 Non-Refundable Application Fee is required. Your application will not be processed without the fee, please be sure to submit the application fee at the end of this application.

Enter all information requested accurately as this helps us to match up the right dog with your family. Should you receive an invalid error message upon submitting this form, please go back through and fill out any missed questions. You will be contacted within ten days of receipt of your application to let you know we have received and are processing it.

NOTE: EVERY question MUST be answered even if the answer is “n/a”

Contact Information
Form submission will automatically record date and time when application was completed.
Full Name *
Your answer
Spouse/Partner's Name *
Your answer
Email *
Your answer
Home Phone (or cell if no land line) *
Your answer
Cell Number *
Your answer
Work Number *
Your answer
Best Time to Call *
Your answer
Can You Be Contacted at Work? *
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
How did you hear about MWBTR? *
Your answer
Family Information
Number of adults in the home *
Your answer
Number of children in the home (or frequent visitors) and ages *
Your answer
If you don’t currently have children, do you plan on having children in the future? *
If you have children, have they been taught how to behave around dogs and that animals deserve to be treated with respect? *
Your Occupation and Employer *
Your answer
(Spouse/Partner) Occupation and Employer *
Your answer
Are you a college student? *
Are you in the military? *
Have you or any members in your household been convicted of a crime against animals? *
If yes, please explain *
Your answer
Personal References
Please list three personal references, not living with you. Include NAME, PHONE, & EMAIL address.

Please inform these individuals that we will be contacting them.

PLEASE NOTE: Though you may think our adoption procedures are a bit stringent, please remember that many of our Boston’s have already been separated from a home, and not always a loving one. Some have been through the frightening experience of being in a shelter, or found as strays. We try very hard to make the adoptions successful, and make the best possible decisions for the Boston. Our adoption process helps to assure us that you are ready for the commitment and responsibility of adopting a Boston into your family. Our top priority is adopting the right Boston into the right home. Adoptions are not completed unless everyone is happy... you, the Boston, and Midwest Boston Terrier Rescue members involved.

Reference 1 *
Your answer
Reference 2 *
Your answer
Reference 3 *
Your answer
Home Information
Please select the style of your home *
How long have you been at this address? *
Your answer
If you rent or lease, have you confirmed with the landlord that pets are allowed? *
Please email a copy of your lease agreement to mwbtr.bostons@gmail.com Also, if you rent or lease please complete the additional questions below.
Landlord Name *
Your answer
Address *
Your answer
City/State/Zip *
Your answer
Phone Number *
Your answer
Property Information
If your yard is fenced, please describe the area and type fence *
Your answer
If you do not have a fenced yard, what arrangements do you plan to make for exercise and toilet duties? *
Your answer
Do you have a doggie door? *
If so, does it open into a fenced enclosure? *
Do you have a pool or spa? (Required) *
Is pool or spa fenced? *
If yes, what type of fencing? *
Your answer
What is the activity level of your household? *
Have all members of the household agreed to adopting a Boston Terrier? *
If No or Maybe was answered above, please explain *
Your answer
Are any members of your household allergic to dog hair or dander? *
Would you be willing to take your pet to a behaviorist or trainer if necessary (i.e., if through your own efforts you were unable to train the dog or its current behavior) *
Would you make the time to take your pet to participate in training/obedience, etc.? *
If you move, what will you do with this animal? *
Your answer
If you have a baby, what will you do with this animal to acclimate it with the new baby? *
Your answer
Do you have time to exercise and play with this animal? *
When you are not home, how will you confine your pet? *
Your answer
What are your thoughts to crate training as opposed to other confinement methods? *
Your answer
Do you understand that Boston Terriers do not tolerate extremes in temperature and are required to be indoor dogs? *
Do you understand that Boston Terriers are high energy dogs and require a lot of exercise? *
Do you understand that Boston Terriers can be destructive to toys, furniture, and other things? A bored dog is a destructive dog!!! *
Do you understand Boston Terriers are people dogs and need to be with their people to maintain their happiness? *
Do you agree to return this dog to Midwest Boston Terrier Rescue if you are unable to keep it for any reason? *
Do you agree that the dog will not be used as a guard dog, or dog fighting bait dog, or be used for breeding or experimentation purposes? *
Do you agree that in no event will the dog be sold or given away to another person or placed in an Animal Shelter or Humane Society or turned loose to run loose. *
Do you agree to properly house, feed, water, exercise and care for and provide inoculations, heartworm care and other veterinary or supportive care as the dog requires? *
Do you agree to exercise proper control and restraint over the dog at all times and will not allow the dog to run at large? *
Do you agree to have a collar and identification tags on the dog at all times, even if the pet stays indoors? *
If/when you adopt a Boston Terrier, how much time do you think it will take for your new dog to adjust to the family and other pets? *
Your answer
How do you plan on getting the Boston Terrier to you? *
Your answer
Pet Information
Please complete the following information. This information helps shorten the adoption process.
Is there a particular Boston or Boston mix on our Website/Petfinder that you are interested in? *
Your answer
What do you like about the dog you are interested in adopting? *
Your answer
Would you prefer *
Would you consider a Boston Terrier Mix? *
Have you owned a Boston Terrier Before? *
Age Preference *
Please keep in mind that it is highly unusual to find a rescue dog that is young (1 year or younger). Any puppies in rescue under six months of age. Will only be adopted out on a spay/neuter contract and requires a $100 deposit (in addition to the adoption fee). The $100 deposit will be refunded to you upon proof of spay/neuter. (Check All That Apply)
Required
Our rescue dogs are not all perfect, are you willing to put extra time and effort with training the dog to become a household pet, if necessary? *
Is it important that the dog you are interested in be partially housebroken? *
We rarely get completely housebroken dogs into rescue. So be prepared for a long wait if you are not willing to work with a dog on housebreaking.
If your dog has a housebreaking accident when you are not home, how will you deal with it? *
Your answer
How about when you are at home? *
Your answer
If your dog chews an inappropriate object, what will you do? *
Your answer
What form of discipline will you use on your dog? *
Your answer
What are your feelings about crate training? *
Your answer
Are you willing to adopt a dog with known health problems? *
If YES, what kinds of health problems are acceptable? (Check all that apply) *
Required
Are you willing to adopt a dog with behavior problems? *
If so, what behavior are you willing to work with? (Check all that apply) *
Required
I want my new pet to be *
Required
What are you looking for in a Rescue dog regarding personality, behavior, looks, etc.? *
Your answer
Will your current pet(s) accept a new dog? *
If yes, how do you feel they will react? *
How would you characterize your pets behavior? *
Required
Where will the pet be kept during the day when you are not at home? *
Where will the pet be kept at night? *
How long will the pet be left alone each day? *
Do you have a dog sitter or dog walker? *
Who will be responsible for caring for this dog’s daily needs? *
Required
Have you ever had a pet get lost, die at an early age, or die in an accident? *
Your answer
Have you or your spouse/parter ever given up a pet? *
Your answer
How will you correct inappropriate behavior problems? *
Your answer
Exercise and elimination will be *
Required
What are some of the things you enjoy most about having a pet? *
Your answer
Why did you choose a rescue group? *
Your answer
What will your first day with the dog be like? *
Your answer
What will you do if your dog runs away (i.e., who will you call and what will you do to get it back)? *
Your answer
Please list the current and past pets that you have owned.
PET 1 (Name & Breed) *
Your answer
Pet 1 Info *
Required
PET 2 (Name & Breed) *
Your answer
Pet 2 Info *
Required
PET 3 (Name & Breed) *
Your answer
Pet 3 Info *
Required
PET 4 (Name & Breed) *
Your answer
Pet 4 Info *
Required
PET 5 (Name & Breed) *
Your answer
Pet 5 Info *
Required
If you need additional space for pets, use "Additional Comments" area at end of this application.
If you no longer own the pet, why? *
Your answer
Have you filled out an adoption application with any other rescue or organization? *
If yes, to whom have you applied to and when? *
Your answer
Have you adopted a dog from a Rescue or Shelter in the past? *
If so, from whom and when did you adopt? *
Your answer
When transporting your dog, what form of transportation do you use? *
Required
Vet Information
Please provide your current Veterinarians information. If you do not have a Veterinarian, please provide the contact information of the Veterinarian that you are planning to use for your pet.
Veterinarian Office *
Your answer
Veterinarian Name *
Your answer
Address *
Your answer
Telephone Number *
Your answer
What yearly costs do you expect for the standard care and maintenance of your pet(s)? (i.e. shots, exams, food, etc.) *
Your answer
In the event of a medical emergency, what kind of costs are you prepared to handle? *
Your answer
In the event you or another household member lost your job, are you financially prepared to afford the expense of owning this new dog? *
Your answer
What heartworm preventative do you and/or your Veterinarian use: *
Your answer
Veterinarian Release
By signing below I hereby give permission for any veterinarian providing service to me/my animals to release medical information on any/all of my animals to Midwest Boston Terrier Rescue (its agents).

This release is not limited to the veterinarian named below. Please let your veterinarian know we will be calling for a vet reference.

Current Veterinarian *
Your answer
Telephone *
Your answer
Address *
Your answer
Electronically signed by (required) *
Your answer
If you have additional information or comments that would assist us in evaluating this application, please attach an additional page.

By completing and submitting this application:

1. I/We understand that this application is only an interviewing tool, and my submission of this application in no way guarantees the placement or availability of a Boston to my family.
2. I/We understand that applications will not be returned.
3. I/we understand that applications with unanswered questions will not be processed.

The answers you give us 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 all volunteers, so please expect some waiting time (1-3 weeks) to be contacted about your application.

Do you realize that it can take up to a month for all the reference checks, home visits, and finding the right dog for you to be done? *
Are you willing to wait this long? *
$20 APPLICATION PROCESSING FEE
Every application submitted requires a $20 processing fee.
Please click PayPal link below (donation button on homepage also works) or mail to the following address:

MWBTR, 2724-2 Niles Avenue, St. Joseph, MI 49085
Applications will NOT be processed until fee is submitted.

PAYPAL - PAY $20 APPLICATION FEE
Please click the link below to go to our homepage. Then click on the big red DONATE button on the right hand side to make a payment.

www.midwestbtrescue.org

How will you be submitting your $20 Application Fee? *
We reserve the right to refuse any applicant for any reason and the right to inspect the prospective home environment both before and after the adoption, without any advanced notice.

If we discover that any information on this form was knowingly falsified, it will be denied. Further, if any information is knowingly falsified, and the adoption/transfer of the dog has taken place, we reserve the right to take the dog back into our possession.

If/when your application in approved you will be contacted by a representative of Midwest Boston Terrier Rescue. This adoption fee is charged to help defray the costs of veterinary care for our rescued dogs. At the time of adoption, you will be required to sign an adoption contract committing to the care of the dog. A mandatory part of that care is monthly heartworm preventative (or a yearly heart worm shot). Please remember that Boston Terriers are high-energy, people oriented dogs that require a great deal of exercise and human companionship. And cannot tolerate extremes in temperature and should be kept inside as house dogs.

All Boston’s in our rescue receive the following care: comprehensive examination by a licensed veterinarian; fecal test; spay or neuter (unless there is a significant health risk or under 6 months of age); heartworm test and treatment; heartworm preventative; treatment of known illness, medical problems, malnourishment, etc., before they will be adopted out.

Electronically signed by (required) *
Your answer
I understand that my application will be reviewed by the Midwest Boston Terrier Adoption Committee and will be notified by email or telephone of any questions, concern, and or decision to approve or deny my application.

I understand that if my application is approved and a Boston matching the criteria I have provided is available in the rescue, I will be contacted for a Home Visit. After a successful Home Visit is performed, I will be contacted by Midwest Boston Terrier Rescue for an adoption.

Electronically signed by (required) *
Your answer
Add any additional comments that you'd like us to know more about here *
Your answer
Thank you for your interest in adopting a rescued Boston Terrier!

If you end up adopting another dog during this process, or have questions,
please contact Midwest Boston Terrier Rescue: MWBTR.Bostons@gmail.com

Please make sure you also submit the $20 application fee.

PLEASE MAKE SURE YOU HAVE FILLED IN ALL FIELDS OR YOUR APPLICATION WILL NOT GO THROUGH.

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