Address:

Home Phone: Work Phone:

Email Address:

Employer Name and Address:

What age and Sex are you interested in?
Age: Puppy Adult Elderly Any age is fine Sex: Male Female Either is fine

Are you willing to adopt a dog with some medical or behavioral issues? Yes No Maybe

Have you owned a dog before? How many, what breed, age, sex?

Name and address of your veterinarian:

Veterinarian's phone:

How did you lose your last dog?

Do you own other pets? What Kind?

Will you train your Boston Terrier
through basic obedience? Yes No Maybe

How do you feel about crate training?

Do you own your own home? Yes No

If you rent an apartment or house, are you permitted to have dogs? Yes No I don't Know

Do you have a fenced yard? Yes No

Does anyone in the house have animal allergies? Yes No I don't Know

How many people are there in your household? 1 2 3 4 5 6 7 8 9 10

What are the ages of your children?

How many hours a day will the Boston be left alone?

Where will your Boston be kept during the day?

Where will your Boston be kept at night?

What will the arrangements be when you go on vacation?

Are you financially able to provide for the needs of this dog? Yes No I don't Know

May we visit your home to verify present
and future suitability for this Boston? Yes No

Address:

Relation to you:

Signature: Date: