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Mississippi Boston Terrier Rescue
Adoption Application

Please fill out the application COMPLETELY and when finished, hit the "Submit"
button at the bottom of the page to send your application to us.
2-Address
:
1-Name:
3-City:
4-State
 5-Zip:
6-Home Phone:
7-Work Phone:
8-Cell Phone:
9-E-mial:
10-Occupation:
11-If you are interested in a particular Boston/Bostons, please list their names:
12-Please list the other pets you have owned in the last 5 years:
1- Name:
 Gender:
Breed:
 Age:
Is Pet Spayed/Neutered?
Where is this pet now:
2- Name:
 Breed:
 Age:
 Gender:
Is Pet Spayed/Neutered?
Where is this pet now:
Gender:
3- Name:
 Breed:
 Age:
Is Pet Spayed/Neutered?
Where is the pet now?
Age:
4- Name:
 Breed:
 Gender:
Is Pet Spayed/Neutered:
 Where is the pet now?
Age:
Breed:
 Gender:
5- Name:
Is Pet Spayed/Neutered:
Where is the pet now?
What is the name of your Veterinary Clinic:
13-Vet's Name:
 14-Vet's Address:
15-Vet's State/Zip Code:
16-Vet's Phone Number:
16-Are all your pets up-to-date on vaccinations:
17-Are your pets on Heartworm Preventative:
18-Have you ever surrendered a pet to a shelter?
 19-f "Yes", please explain:
20-How many people live in your household?
 21-Please list their ages?
22-Do you have small children who frequently visit your home?
23-Does anyone in your household have an allergy to dogs?
24-Does anyone in your household smoke?
25-How many hours a day would the Boston be left alone?
26-Where would the Boston stay while you are away?
27-Are you familiar with a dog crate?
 28-Are you willing to use one for training?
29-Is everyone in your family in agreement regarding adopting a Boston?
30-Do you own or rent?
31-If you rent, do you have your landlord's permission to have a dog?
32-Please list Landlord's name, address, and phone number?
33-Do you have a fenced yard?
34-What is the height of the fence?
35-What type of fence is it?
 36-What is the size of fenced area?
37-If you do not have a fenced yard, are you willing and committed to leash walking?
38-Where will the Boston stay while you are out of town?
39-Where will the Boston sleep at night?
40-Would you consider a dog that is not fully house trained at the time of adoption?
41Would you consider an older Boston or a Boston with special needs?
42-Are you aware that vet bills/routine care can range from $100-$500 a year?
43-Are you aware that Bostons shed heavily year round?
44-Are you aware that Bostons are NOT "outside" dogs and are susceptible to heat/cold?
45-Will your Boston live primarily outdoors?
46-Have you owned a Boston before?
47-Where did you learn about this breed?
48-Are you aware that Bostons snort, "reverse sneeze", and can snore loudly?
49-Are you aware that Mississippi BTR requests an adoption fee for each adoption to help cover
expenses incurred in readying the dog for adoption?
50-Are you prepared to pay this fee?
51-Are you aware that if you adopt a Boston, you are taking on the responsibility for it's lifetime
which may be up to 14-15 years?
52-Please tell us why you want to adopt a Boston and how you plan to include it into your family?
53-Because of the time involved in processing an application, we ask that you apply to only one
rescue at a time.  Have you applied, or do you have an open application with another rescue
organization?
54-If "Yes", which organization have you applied to?
55- PLEASE NOTE- We do not ship our dogs.  If you live outside of our service area it will be your
responsibility to pick up your dog in person.  Are you willing to do this?
56- If you were no longer able to care for your Boston, what would you do with it?
57- If the new dog did not get along with your current pets, how would you cope with the situation?
58- Because we receive so many applications that are filled out on a "whim" or without putting
much serious thought into it, we must now require a $10.00 non-refundable application fee before
we can process your application.  We apologize to all the "serious" inquiries about this but feel it is
necessary due to all the time that volunteers waste on apps. filled out on the spur of the moment.  
The fee can be paid securely with a credit card  via paypal using the paypal button button directly
below the "submit" button on this form.  Do you understand this policy and in agreement:  
59- I understand that MBTR has the right to deny/approve this
application at their discretion:
60- Where did you hear about MS Boston Terrier Rescue:
61- I have you read and fully understand all the information on the "Adoption Information" page.
Electronic Signature:
Date:
Once you have answered all the above questions, hit the "Submit"
button below to send your application to us.  Please make sure that
you have answered each question and that you have submitted your
application fee.  Incomplete applications can not be processed.
***Note to Potential Adoptors:  We have some wonderful dogs available for adoption who would
love to have a family of their very own.  However, before you even fill out an application, we want
you to realize that Lassie, Rin Tin Tin, Benji, and Toto do not come into rescue.  We don't get the
elegantly coiffed, classically beautiful, absolutely healthy, completely trained, perfectly behaved,
flawless dog. We get the leftovers; dogs that other people have incompetently bred, inadequately
socialized, poorly cared for, ineffectively "trained," and badly treated. Most Rescue dogs have had
it. They've been pushed from one lousy situation to another.  They've never had proper veterinary
care, kind and consistent training, or sufficient company.  They're scared, depressed and anxious.
Some are angry. Some are sick or injured.  There's always more dogs than rescuers but we make
every effort to correct any problems we can with the dogs.  However, we can't always offer you a
"flawless" dog.  We invest all the blood, sweat, tears, and money, often from our OWN pockets and
never enough to cover all the bills, that we can into these dogs.  So don't come to rescue in the
hopes of getting a "bargain" or getting a dog that is already completely house broken and
obedience trained.  indeed, you shouldn't come to rescue in the hopes of "getting" anything. We
will only adopt to compassionate people who we feel are as committed to these dogs as we are,
even if there are some "flaws" that may come with them.  When you come to Rescue to adopt a
needy Boston, come to give, to love, and to save a life....not to get a "bargain" dog that someone
else has already house trained.  We are here to find people for our dogs, not to find dogs for people.
Before submitting an adoption application, please read the "ADOPTION
INFORMATION" page.  It will provide you with all the information you
need regarding the adoption process as well as our adoption policies and the
required adoption fees.  If you live outside our service area, e-mail us prior to
filling out an application as sometimes logistics or lack of contacts in your
area prevent us from obtaining a home visit.  If there is something that you
do not understand, please e-mail us at msbostonrescue@yahoo.com and we'll
be happy to answer any questions you may have.

Mississippi Boston Terrier Rescue
P.O. Box 330
Bay Springs, MS 39422
Fax:  (601) 764-2166
e-mail:  msbostonrescue@yahoo.com
Your application will remain active for three months from the day you fill it out unless we are still actively
trying to place the right dog with you.  If there has been no activity in three months, and we have not heard
from you or you have not asked us to "renew" your application.  It will be deleted from our files for the sake of
storage space and you will have to fill out a new application and begin the process from start if you decide
later that you wish to adopt.  Because of limited storage space, we are unable to keep files open indefinitely.