*Name:

*Occupation:

Spouse's Name (If Applicable):

*Email Address:

*Home Phone:

Work Phone:

Cell Phone:

*Are you interested in a specific adoptable dog from our website? *Are you interested in a specific adoptable dog from our website?YesNot Applicable

*Which dog on our website would you like to learn more about?

*How did you hear about our rescue? *How did you hear about our rescue? Word of Mouth Community Event Social Media (Facebook, etc) Google Search Other (Please Describe)

*How did you hear about our rescue?

*What is the best time for us to contact you? *What is the best time for us to contact you?MorningMid-DayAfternoonEveningAny TimeOther

Please provide more information on the best time to get in touch with you:

*Street Address:

*City:

*Province:

*Postal Code:

How long have you lived at your present address?

*Home Type: *Home Type:ApartmentHouseCondoOther

*Do you rent or own your home? *Do you rent or own your home? Own Rent

Please note: renters must provide additional documentation from their landlord which specifics that dogs are allowed in the dwelling. Documentation can be emailed to btprmb@gmail.com. Please note: renters must provide additional documentation from their landlord which specifics that dogs are allowed in the dwelling. Documentation can be emailed to btprmb@gmail.com.

A fenced-in yard is required for the Adoption Application to be approved. Please select how the dog will access the yard for exercise and elimination: A fenced-in yard is required for the Adoption Application to be approved. Please select how the dog will access the yard for exercise and elimination: Doggie Door Totally Fenced-In Yard Partially Fenced In-Yard or Area Future Plans for Fenced-In Yard or Area Other (Please Describe)

Boston Terrier and Pug Rescue of Southern Manitoba requires a totally fenced-in area for ALL adopted dogs. This requirement is for the safety and well-being of the dogs. Boston Terriers and Pugs are indoor dogs, however due to their activity level they still require freedom outdoors without a leash. If you do not currently have a fenced-in area but are planning to install one in the near future, please continue to complete and submit this application. If there are no plans for a fence you will not qualify. Please note: if you live in a pet-friendly apartment or condo complex this requirement may be waived. Dog owners would be required to abide by local leash laws at all times. Boston Terrier and Pug Rescue of Southern Manitoba requires a totally fenced-in area for ALL adopted dogs. This requirement is for the safety and well-being of the dogs. Boston Terriers and Pugs are indoor dogs, however due to their activity level they still require freedom outdoors without a leash. If you do not currently have a fenced-in area but are planning to install one in the near future, please continue to complete and submit this application. If there are no plans for a fence you will not qualify. Please note: if you live in a pet-friendly apartment or condo complex this requirement may be waived. Dog owners would be required to abide by local leash laws at all times.

Please provide more information as to how the dog will access exercise and elimination:

What Type of Fence Do You Have? What Type of Fence Do You Have? Wood Plastic Chain Link or Metal Other (Please Describe)

Please provide more details about the type of fence you have:

What is the height of your fence? What is the height of your fence? 4 Foot 5 Foot 6 Foot Other (Please Describe)

Please provide more details about the height of your fence:

Does your fence have any holes or gaps in it? Does your fence have any holes or gaps in it? Yes No

Please provide details and describe the gaps or holes in your fence, including location and size:

Adoption candidates living in a dog-friendly apartment or condo will be expected to abide by local leash laws at all times. Please select how the dog will access the yard for exercise and elimination: Adoption candidates living in a dog-friendly apartment or condo will be expected to abide by local leash laws at all times. Please select how the dog will access the yard for exercise and elimination: Outdoor fenced pet relief area Leashed outdoor visits, walks, or park Indoor litter box/elimination area Other (Please Describe)

Please provide more information as to how the dog will access exercise and elimination:

Please provide more details about your type of home:

*Does the primary animal caregiver work: *Does the primary animal caregiver work: Full-Time Part-Time Retired or Not Currently Working Other

Please provide more information about the work schedule of the primary animal caregiver:

Do you work from home? Do you work from home? Yes No Sometimes

Please specify how many hours the primary animal caregiver works from home in a week:

*Will there be any provisions made if you are away during your adoption trial time? Please provide additional details:

*On average, how long will this dog be left alone each day?

*Where will the dog be kept while at work? *Where will the dog be kept while at work? Kennel or CrateDog BedSpecific Area or RoomRun of the HouseOther

Please provide additional information on where the dog will be kept while you are away at work:

*Where will the dog be kept at bedtime? *Where will the dog be kept at bedtime?Kennel or CrateDog BedSpecific Area or RoomRun of the HouseOther

Please provide additional information on where the dog will be kept at bedtime:

*Where will the dog be kept while no one is home? *Where will the dog be kept while no one is home?Kennel or CrateDog BedSpecific Area or RoomRun of the HouseOther

Please provide additional information on where the dog will be kept when no one is home:

*Where will the dog be kept while on vacation?

*Who will be responsible for this dog?

*If you move, what will you do with this dog?

*Does any one in the household have allergies to dogs? *Does any one in the household have allergies to dogs? Yes No

*Please provide more information

*Do you have any children at home? *Do you have any children at home?YesNo

Are there any plans for children in the future? Are there any plans for children in the future? Yes No

*How many children VISIT your home and what are their ages?

*Please list ALL members in your household including yourself: *Please list ALL members in your household including yourself:

Name

Age and Relation

Name

Age and Relation

Name

Age and Relation

Name

Age and Relation

Name

Age and Relation

Name

Age and Relation

Name

Age and Relation

Please list ALL pets that currently live in your household: Please list ALL pets that currently live in your household:

PET #1 PET #1

Pet Type

Breed

Gender

Age

Spay or Neuter? Spay or Neuter?YesNo

Please explain why:

PET #2 PET #2

Pet Type

Breed

Gender

Age

Spay or Neuter? Spay or Neuter?YesNo

Please explain why:

PET #3 PET #3

Pet Type

Breed

Gender

Age

Spay or Neuter? Spay or Neuter?YesNo

Please explain why:

PET #4 PET #4

Pet Type

Breed

Gender

Age

Spay or Neuter? Spay or Neuter?YesNo

Please explain why:

*If you are a dog owner, does your dog have up-to-date vaccinations against rabies, distemper, parvo, and bordetella? *If you are a dog owner, does your dog have up-to-date vaccinations against rabies, distemper, parvo, and bordetella? Yes No Partially Vaccinated (Please describe)

Please provide more information about the vaccines that your dog has received:

*Are your current dogs licensed with the City of Winnipeg or the town/community in which you reside? *Are your current dogs licensed with the City of Winnipeg or the town/community in which you reside? Yes No Not Applicable

*What kind of food do you feed your current dog, or plan to feed an adopted dog?

Boston Terrier and Pug Rescue of Southern Manitoba recommends a high quality diet (Horizon, NutriSource, Eagle Pack, Acana, Orijen, Royal Canin, etc) due to a variety of health problems these dogs can be susceptible to. If you are currently feeding a non-premium food (Pedigree, Beneful, Iams, Ol' Roy, Purina, etc) we would urge you to visit your local pet store to discuss canine nutrition and recommendations. A member of the Boston Terrier and Pug Rescue of Southern Manitoba would also be happy to discuss food choices with you. Boston Terrier and Pug Rescue of Southern Manitoba recommends a high quality diet (Horizon, NutriSource, Eagle Pack, Acana, Orijen, Royal Canin, etc) due to a variety of health problems these dogs can be susceptible to. If you are currently feeding a non-premium food (Pedigree, Beneful, Iams, Ol' Roy, Purina, etc) we would urge you to visit your local pet store to discuss canine nutrition and recommendations. A member of the Boston Terrier and Pug Rescue of Southern Manitoba would also be happy to discuss food choices with you.

*Have you ever lost a pet, had it die at an early age, or had it die due to an accident? *Have you ever lost a pet, had it die at an early age, or had it die due to an accident? Yes No

Please provide details

*Have you ever given away a pet before? *Have you ever given away a pet before? Yes No

Please provide details:

*Have you ever euthanized (put to sleep) a pet before? *Have you ever euthanized (put to sleep) a pet before? Yes No

Please provide details:

*Have you ever surrendered a pet to a shelter or rescue group? *Have you ever surrendered a pet to a shelter or rescue group? Yes No

Please provide details:

*How much money do you plan to spend on the dog each year (including food, toys, medical bills, boarding, grooming, etc)?

*If you were met with an unexpected vet bill, would you have the resources to cover it? *If you were met with an unexpected vet bill, would you have the resources to cover it? Yes No Unsure

*Please describe what you would do if you were met with an unexpected vet bill:

*What would be the maximum you would spend on surgery or medical treatment?

*What would you do if you were unable to meet a dog's needs financially?

*Why do you want to adopt a Boston Terrier or Pug?

*Have you done any research on the breed you are interested in? *Have you done any research on the breed you are interested in?YesNo

*Do you know what to expect in terms of health problems, energy levels, and care requirements? *Do you know what to expect in terms of health problems, energy levels, and care requirements?YesNoUnsure

Boston Terriers and Pugs have unique care requirements. Please explore our website for more information about health problems, energy levels, and care requirements of these breeds. Boston Terriers and Pugs have unique care requirements. Please explore our website for more information about health problems, energy levels, and care requirements of these breeds.

Do you have a preference on the gender of dog you would like to adopt? Do you have a preference on the gender of dog you would like to adopt? Male Female No Preference

Do you have a preference on the breed of dog you would like to adopt? Do you have a preference on the breed of dog you would like to adopt? Boston Terrier Pug Mix No Preference

Would you be willing to adopt a dog that was not fully housebroken? Would you be willing to adopt a dog that was not fully housebroken? Yes No

The majority of dogs who come into the rescue will need work on their housebreaking skills. Some will need to be entirely housebroken, especially those who came from living outdoors, or from a backyard breeder or puppymill. Even dogs that have previously been housebroken can still have the occasional accident while the dog adjusts to its new surroundings and routine. The majority of dogs who come into the rescue will need work on their housebreaking skills. Some will need to be entirely housebroken, especially those who came from living outdoors, or from a backyard breeder or puppymill. Even dogs that have previously been housebroken can still have the occasional accident while the dog adjusts to its new surroundings and routine.

Would you be willing to adopt a dog with special medical needs or health problems? Would you be willing to adopt a dog with special medical needs or health problems? Yes No Maybe

Would you be willing to adopt a dog with some behavioural problems? Would you be willing to adopt a dog with some behavioural problems? Yes No

*Please describe the personality preference of the dog you wish to adopt:

*Would you be willing to drive to meet or pick up your new dog? *Would you be willing to drive to meet or pick up your new dog? Yes No

*Have you applied to adopt with any other rescue organizations? *Have you applied to adopt with any other rescue organizations? Yes No

*Which rescue(s) have you applied with?

*Has a home visit been completed?

Please provide the name and contact information for your current veterinarian: Please provide the name and contact information for your current veterinarian:

Vet Clinic Name

Name of Veterinarian

Vet Clinic Address

Vet Clinic Phone Number

May we contact your vet for an animal care reference? May we contact your vet for an animal care reference? Yes No

Please list two other references that we may contact regarding this application request: Please list two other references that we may contact regarding this application request:

REFERENCE #1 REFERENCE #1

Name of Reference

Phone Number

Relation

REFERENCE #2 REFERENCE #2

Name of Reference

Phone Number

Relation

Additional Comments:

By submitting this form you are declaring that all information provided above is true and correct. Any false information will disqualify you from adopting a dog from the Boston Terrier and Pug Rescue of Southern Manitoba. You are stating that you are seeking to adopt a dog, give it a good and loving home, and accept full responsibility for their care. By submitting this form you are declaring that all information provided above is true and correct. Any false information will disqualify you from adopting a dog from the Boston Terrier and Pug Rescue of Southern Manitoba. You are stating that you are seeking to adopt a dog, give it a good and loving home, and accept full responsibility for their care. I am over the age of 18 and am the person responsible for making pet decisions in my family I agree to abide by all local animal control and leash laws and understand it is my responsibility to be familiar with them I accept that all information provided in this form is true and correct and give permission to contact the references listed above