Adoption Application Form

Adoption Application

Old Dominion Boston Terrier Rescue is a 501c3 non-profit serving VA, Northeastern NC, MD, DE and DC
The following application is required for adoption of our dogs, regardless of any other applications you may have completed at other rescues. We will not share your information with other rescues, unless it is at your request. (Other rescues would still require you to complete their application).
AVAILABLE DOGS are listed HERE. If the dog you are interested in does not appear HERE, please select "UNAVAILABLE" on your application when asked. This prevents wasted time and effort processing applications prematurely. All applications are processed in the order they are received. If the dog you like is unavailable, we will hold your application in order to begin processing when and if the dog's status changes to AVAILABLE.
Please review the entire application first, so you can be sure to have all the information on hand before beginning. It is lengthy, and you won't be able to "save" and return to it later. Please do not leave anything blank. Complete all fields, using "N/A" for anything not applicable to you.

* Indicates required field

I. Personal Information

Name *

First

Last

Email *

The dog I want is: *

Available for adoption (listed on this site). Unavailable (not yet listed) I have no specific dog in mind

Name of desired dog (if applicable) *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Are you over 18 years old? *

Yes No

Main Phone Number *

Cell Phone Number *

Alternate Phone Number *

Best time to call? *

If under 18, are your parents are agreeable to your adopting an animal? *

Yes No

Have you recently completed an application with any other rescue group? *

Yes No

Have you adopted from a rescue in the past? *

Yes No

Name and details of previous rescue groups you have dealt with in the past. *

NOTE: We do our best to match applicants with dogs. Please understand that the dog you are most interested in may not be the best match for your home and family.

>> Applicant digital signature below certifies accuracy and veracity of all items included in Section I. "Personal Information". *

II. Personal References

NOTE: Personal references must meet the following requirements:

Not a family member by blood or law
Not living in the same household
Is relevant for this purpose (Please choose someone familiar with you in your role of pet owner!)

First Reference *

First

Last

Relationship (NOTE: cannot be family members or members of the same household) *

Phone Number *

Email *

Alternate Phone Number *

Second Reference *

First

Last

Relationship (NOTE: cannot be family members or members of the same household) *

Phone Number *

Email *

Alternate Phone Number *

>> Applicant's digital signature below certifies veracity and accuracy of all items under Section I. Personal Information and Section II. Personal References. *

III. Veterinary References

Please note that if you currently own a pet or have owned one in the last 10 years, your vet's name is required to process your application.

NOTE: You MUST contact your Veterinarian and notify them of our pending inquiry. They will not answer our questions without your prior permission. Your application will be suspended if your vet declines to speak to us.

1. Do you have a regular veterinarian? *

Yes No

2. The reason I cannot supply a vet reference is: *

3. Name of Vet Hospital/Clinic *

4. Your Veterinarian's Name *

First

Last

5. Vet Hospital/Clinic's Address *

Line 1

Line 2

City

State

Zip Code

Country

6. Vet's Phone Number *

7. Vet's Fax Number or Email *

8. How long have you been with this Vet? *

9. If you currently own a pet, who is listed as its owner on your vet’s paperwork? *

IV. Previous and Current Pets

1. Currently owned dog’s name, age, gender, and breed: *

2. Are your current pets up to date on their annual vaccinations? *

Yes No Not Applicable

3. Are your pets on heart worm prevention? If yes, what brand? *

4. Are your current pets spayed / neutered? *

Yes No Not Applicable

5. If not, please explain why? *

6. Please list all PAST DOGS names, ages, gender, breed, number of years you owned them and what became of them (past ten years). *

7. Do you own cats? *

Yes No

8. Any other animals? If so, please list them here. Include species, ages and years you have owned them. *

9. Are your pets on flea and tick prevention? If yes, what brand(s)? *

>> Applicant's digital signature below certifies veracity and accuacy of all items under Section III. Veterinary References and Section IV. Previous and Current Pets. *

V. Compatibility

1. Why have you chosen to adopt a Boston Terrier? *

2. Gender Preference *

Female Male No preference

3. Describe age preference (specify puppy, adult, mature or senior): *

4. Role of dog you are seeking (specify companion, agility competitor, guard dog, therapy dog or any other role): *

5. Describe issues you are willing to work with (specify house training, separation anxiety, chewing, digging, fear, licking, *

6. House training can take weeks, months or longer. Are you willing to accept house training accidents in your new dog? *

NOTE: EVEN PERFECTLY HOUSEBROKEN DOGS HAVE ACCIDENTS. If you are not willing to work with housebreaking issues, then a rescue dog may not be for you!

7. Describe health issues you are willing to accommodate (specify allergies, arthritis, heart problems, incontinence, skin problems, cancer or say "healthy dog preferred") : *

8. Describe physical issues you are willing to accommodate in your new dog (specify blindness, deaf, limp, one-eye, three-legs, scars and other disfigurements, multiple disabilities or say "no physical disabilities preferred") : *

9. Describe personality traits you might prefer in your new dog {specify couch potato, lapdog, laid back, medium energy, active, turbo drive or other qualities) : *

NOTE: Household rules can be a good idea in the case of a dominant or high energy dog, and completely unecessary in a quiet senior. Please be honest about the types of privileges you would allow your new dog.

10. Household privileges you plan to afford your new dog (specify sleeping on your bed, on furniture, no furniture, doggie bed, or unfettered access to your home) : *

11. Where will the dog spend the day? (Specify loose indoors, crated indoors, basement, garage, outdoor kennel, barn, day care, etc) *

12. On average, how many hours will the dog be without human company daily? *

13. Where will the dog spend the night? (Specify loose indoors, crated indoors, basement, garage, outdoor kennel, barn, day care, etc) *

14. What brand of dog food do you intend to feed your dog? *

>> Applicant's digital signature below certifies agreement with and accuracy of all items under Section V. "Compatibility". *

VI. Home Environment

Some Bostons are absolutely perfect for apartment / high rise living. Some absolutely are not. Please be completely honest about your home environment so that we can recommend the very best dog for it. Complete all fields, using "N/A" for items not applicable to you.

1. Do you own or rent your home? *

2. Type of Home (apartment, single family, duplex, townhome)? *

If less than 1 year, please include previous address and length of time there.

3. How long have you lived at this address? *

4. If renting, do you have your landlord's permission to keep a dog? *

5. If renting, have you paid your pet deposit? *

6. Amount of pet deposit paid/required? *

7. Landlord's Business Name (if applicable) *

8. Landlord's Name *

First

Last

9. Landlord's Phone Number *

NOTE: If renting, or if you live in a condominium/co-op, or if your house is a part of a homeowner's association, prior to adoption, you will need to provide a copy of the bylaws, rules and regulations of such association highlighting any restrictions or sections regarding dog ownership, to include rules, responsibilities, and limitations.

I am subject to pet restrictions and will provide a copy of the lease, or of the rules and responsibilities concerning pet ownership with relevant areas highlighted for your perusal. I am not part of a homeowners association of any kind, and therefore not subject to any pet restrictions.

10. Are you aware of the number of dogs/pets allowed by law per household in your city/county? If so, please state the number here or say "I don't know". *

11. Describe your street (specify busy, quiet, cul-de-sac, etc): *

12. Describe your locale (specify rural, farm, country, suburban, urban, city, etc): *

NOTE: Boston Terriers can have a surprisingly high and powerful vertical leap, easily clearing a standard baby gate.

13. Do you have a fenced yard? *

14. Describe your fence material, style and height: *

15. Does the fence completely enclose the yard for the dog? Is there a lock on external gates? *

16. Do you have a swimming pool? If so, is it fenced internally, or would the dog have free access to it? *

17. Do you have a "doggie door" or "cat window"? If so, does it provide access to a fenced or unfenced area? *

18. If no fence, how will you handle the dog's exercise and toilet duties? *

19. Will the dog have access to any of the following: a) garage b) basement or c) outdoor shed ? *

21. Are there any animal-related allergies among the residents of the home? If yes, how will you deal with that? *

22. How many children living in the home? *

22. Name, age, and gender of children: *

23. Describe the children's experience / comfort level with dogs: *

24. Have you or anyone in your family given up a dog to an animal shelter, rescue, family member or other person? If yes, please explain why. *

25. If you or anyone in your home has had a pet become lost or deceased, please list them here by name with a short explanation about each. *

26. Please initial here to certify that as the applicant, you represent that no member of the household has ever been charged with cruelty to animals. *

27. If a member of your family has been charged with cruelty to animals, please elaborate on the circumstances: *

28. Are all members of the home in agreement with adopting this dog? *

YES NO

29. Describe any visitors and/or types of animal visitors, and how often they visit. *

30. Name and age of person(s) who will care for the dog? *

31. In the event of a family relocation, birth or addition of others to the home, what would you do with the dog? *

>> Applicant's digital signature below certifies agreement with and accuracy of all items under Section VI. "Home Environment". *

VII. Fees and Expenses

NOTE: The dog you are applying to adopt has been: spayed/neutered, tested negative for heartworm / lyme /erlichia and vaccinated for bordatella (kennel cough), rabies, DHLPPC and has been microchipped.

1. Your initials below certify that you are willing and able to fund the continued expenses associated with this high standard of routine veterinary care. *

If your application is approved, we will require a NON-REFUNDABLE adoption donation of $100 to $500 depending on the age and health of each dog. This helps to defray the ever increasing cost of veterinary care.

If you feel the adoption fee is high, please be realistic and understand that you may also struggle with the costs associated with dog ownership. Due to the number of veterinary and other services provided to your dog prior to adoption, we are unable to discount our standard fees. Our rescue subsists on adoption fees and donations. In most cases, we have spent more on the dog than the adoption fee amount.

2. Based on the linked article above, how much do you expect to spend per year on vet care? Consider Food, Licensing, Accessories, Grooming and Boarding in your estimate. *

Due to the large number of dogs that come through our rescue, we do not have the funds to fix everything on every dog. We do not routinely fix luxating patella’s, as our vet has advised us that it is an ELECTIVE surgery which may fix it for a few years only to have the problem come back. As long as the dog is not in pain from the patella, we do not fix patellas.

We do fix Cherry eyes, broken bones, have lumps removed and analyzed, remove eyes that have major problems, remove abscessed teeth and or clean teeth during spay/neuter operations, treat mange and other skin problems, have additional blood panels done when a dog's condition warrants it in the vet's estimation, and medicate and treat per the vet's instructions for any medical problems that we are told about or discover during the course of the dog's fosterage on a dog-by-dog basis.

3. How will you collect your new Boston? *

4. Your signature below certifies that you understand that Old Dominion Boston Terrier Rescue derives its only source of funding through adoption fees, donations and fund-raising activities, and for this reason, adoption fees are NON-REFUNDABLE. *

>> Applicant's digital signature below certifies agreement with and veracity of all items outlined in Section VII. "Fees and Expenses". *

VIII. Expectations & Responsibilities

1. Do you understand and agree that any dog you may adopt from ODBTR is REQUIRED to be an indoor dog? *

Yes No

2. Do you understand that Boston Terriers can be destructive to toys, furniture and other things? A bored dog is a destructive dog! *

Yes No

3. What form of discipline would you use if your pet misbehaves? *

4. Would you be willing to take your pet to a behaviorist/trainer if necessary? (i.e., if through your own efforts you were unable to train the dog?) *

Yes No

NOTE: Due to the large number of dogs that come through our rescue, we do not have time to formally obedience train or house train. Sometimes we are lucky and get a well trained one, but most of the time the dogs need someone to love them and work with them to make them into the dogs they are capable of becoming. Adopters are expected to enroll in obedience classes to train their dogs or do the work at home as needed. If you expect perfect behavior, a rescue dog may not be for you.

Please note that ODBTR is NOT a rehab for dogs with major behavioral issues. We do NOT knowingly place a human-aggressive dog in any home, ever, which is why we hold dogs in foster care for several weeks at least, before placement.

5. Old Dominion Boston Terrier Rescue does not knowingly misrepresent any animal's age, condition of health, or temperament. Old Dominion Boston Terrier Rescue is in no way liable or responsible for any damage, injury, or accident resulting from the placement of any dog. *

I understand that Old Dominion Boston Terrier Rescue is in no way liable for the above.

6. There is no health warranty given with the dog. If illness or injury develops or is discovered after adoption, the adopter is responsible for all costs associated with necessary treatment, and obligated to do so. If the adopter is unable to fulfill this responsibility, ODBTR will be notified immediately. The dog will be surrendered to ODBTR at that time. *

I will return the dog to ODBTR in the above mentioned scenario.

7. The dog will not be sold or given away to another person, or placed in an animal shelter (including any humane society), or turned loose to roam freely, under any circumstances. *

I certify the dog will remain in my home, under my care or be returned to ODBTR.

8. The dog will be properly housed, fed, given water, exercise, and routine veterinary care including heart worm preventative and kept free of fleas and ticks for the remainder of the dog's life. *

I agree to keep and maintain this dog as described on this application for as long as the dog shall live, up to an including monthly heartworm preventative medication regardless of climate or season.

9. The dog will have a permanent home as a member of your family and as such, will not be used as a guard dog, yard only dog, dog fighting and/or bait dog or laboratory experiment dog. *

I agree to maintain a loving relationship with this dog, and never "use" the dog for any other purpose, up to an including those mentioned above.

10. The dog will be properly controlled and restrained at all times, and never allowed to run at large. A harness and identification tags will be on the on the dog at all times. *

I agree to keep a harness on the dog at all times, with identification tags securely attached.

11. A will or living trust will include provisions for the care of the dog. ODBTR will be notified of the change of ownership. The adopter agrees and authorizes the dog to be returned to ODBTR if there is no responsible designee, and that ODBTR reserves the right to reclaim the dog. *

I agree to make legal provisions for the dog in the event of my death, and agree that if I fail to do this, the dog will again become property of ODBTR.

>> Applicant's digital signature below certifies agreement with all items outlined in Section VIII. "Expectations and Responsibilities". *

IX. Legal Costs

1. I understand 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 Old Dominion Boston Terrier Rescue. *

I agree.

2. I understand 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 Old Dominion Boston Terrier Rescue. *

I agree.

3. I understand 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 Old Dominion Boston Terrier Rescue. *

I agree.

4. I/We agree that I/we will allow representatives of Old Dominion Boston Terrier Rescue to check the dog and its environment, and that if at any time the placement is found to be detrimental to the dog's health, mental or physical well-being, Old Dominion 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. It is agreed that rescuer shall retain superior title of said animal, limited to and for the express purpose of assuring the animal's well-being and only to exercise its superior claim in the event it appears to rescue that the proper and humane care, as specified in the above adoption provisions, is not being afforded said animal, in which case the animal may be taken through a claim and delivery proceeding. The adopter further agrees that if there is any breach or default of the terms of this contract, and the dog must be redeemed through a claim and delivery service, that the adopter will be held liable for all court costs and fees for the adopter's attorney and for rescuer's attorney. This has been read to the adopter and explained to the adopter. The adopter has read this, understands and agrees to this and is signing this contract. *

I agree.

5. Do you understand that it can take up to a MONTH or MORE for us to get all the reference checks, home visits and finding the right dog for you done. *

I understand.

>> Applicant digital signature below certifies agreement with and accuracy all of the items outlined in Section IX. "Legal Costs". *

NOTE: Please contact us immediately if you should change your mind so that we can discontinue your application progress.

RELEASE OF LIABILITY AND INDEMNITY: I/we promise and agree to be solely responsible for the DOG and do indemnify and hold harmless, Old Dominion Boston Terrier Rescue, agents and representatives, members, successors or assignees from any and all claims of liability for any conduct, behavior, damage or injury caused by the dog to any person of property on or after the date of this agreement; from any claim or damages known or unanticipated resulting from any claim or damages arising by my/our ownership or control thereof. The adopter hereby understands, promises, and agrees that in receipt of this dog to forever release, discharge and covenant to hold harmless rescuer and by other person, firm, or organization charged or chargeable with responsibility or liability, their heirs, administrators, executors, successors, and assignees from any and all claims, damages, and costs, expenses, loss of services, actions and causes of action belonging to the said adopter, arising out of any act or occurrence from the present time and particularity on account of the adoption of ANY ANIMAL adopted from ODBTR.

*OLD DOMINION 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. Even if you fall in love with the looks of a particular dog and submit an application stating that is the dog you want to adopt, we are not obligated to adopt that particular dog to you if we consider the dog is not the right match for your household. We will suggest other dogs that we consider suitable for your household based upon the answers to our questions in the application. This is not an over night process and we are volunteers, so please expect some waiting time (1-6 weeks) 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 refuse to adopt a dog to you and to take any adopted dog back into our possession.

PLEASE NOTE: If your application is approved, we will require a NON-REFUNDABLE adoption donation to defray the ever-increasing costs of veterinary care for our rescued dogs. Also, at the time of adoption, you will be required to sign a contract committing to the care of the dog. A mandatory part of that care is monthly heartworm preventive. In addition, a rescue volunteer will be responsible for confirming that you have visited a veterinarian and obtained heartworm preventative within the time allotted. Preventive medical care is just as necessary for your adopted dog as love, food, and water. Please remember that the Boston Terrier is a high-energy, people oriented dog that requires a great deal of exercise and human companionship. Plus ALL Dogs who have short muzzles cannot tolerate extremes in temperature and should be housedogs. So if you want a dog that does not require a lot of your time and attention, you probably need to look for a different breed. One last note: ALL DOGS adopted from us will be spayed or neutered before being adopted out. We DO NOT provide fertile dogs to be bred to add more puppies to the already overburdened pet population.

I/we, the undersigned (the "adopter"), certify that all of the above information is accurate and complete. I/we understand that if selected and I/we adopt a dog from Old Dominion Boston Terrier Rescue, I must comply with the following: The adopter shall keep the animal as an indoor pet with outdoor privileges and will provide it with proper identification via one or more of the of the following: (a) harness plus ID tag (b) microchip information. The animal will be kept under control at all times, on leash or in a crate, when it is off the adopter’s property. The adopter shall provide adequate veterinary care for the animal, including vaccinations recommended by your licensed veterinarian including but not limited to rabies DHLPP and Bordatella, heartworm preventative 12 months a year and any other care recommended by the animal's veterinarian. The adopter will take the animal to the veterinarian if it is ill. If the adopter is unable to do so, the adopter will notify one of the Old Dominion Boston Terrier Rescue contacts immediately. The adopter agrees to notify Old Dominion Boston Terrier Rescue of any change of address or telephone number within 30 days. If the animal is lost or stolen, adopter will immediately notify Old Dominion Boston Terrier Rescue. The adopter shall return the animal to Old Dominion Boston Terrier Rescue if, for whatever reason, the adopter is no longer able to keep the dog or provide for it. The adopter shall not sell, give or otherwise transfer or convey the animal to anyone other than Old Dominion Boston Terrier Rescue unless directed to do otherwise by ODBTR. Old Dominion Boston Terrier Rescue is not liable for acts of any DOG after placement with adopter.

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

Adopter's printed full name and initials: *

Co-Adopter's printed full name and initials: *

I am not a robot. *

I am a human.

STOP & REVIEW the application. As a team of volunteers with conventional jobs too, we CANNOT and WILL NOT process incomplete applications. If you have left any * required * fields blank, the application will not submit successfully.
If you have left any other fields blank, we will not proceed with processing your application.
Any items not applicable to you should have "N/A" in the field. Look for a "SUCCESS" message to confirm submission. Allow for at least one week processing time before following up via email, and if you do, please put "APPLICATION FOLLOW UP: followed by your full name, in the subject field.
Thank you!

Submit