Apply to Adopt

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

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.

Contact Information

Todays Date (mm/dd/yy):

Full Name:

Spouse/Partner's Name:


Home Phone (or cell if no land line)

Cell Number

Work Number

Best Time to Call:

Can You Be Contacted at Work?
 Yes No

Home Address:



Zip Code:

Family Information

Number of adults in the home:

Number of children in the home and ages:

If you don’t currently have children, do you plan on having children in the future?
 Yes No Not Sure

Have these children been taught how to behave around dogs and that animals deserve to be treated with respect?
 Yes No Have no kids

Are all members of the household in agreement to adopt a Boston Terrier?
 Yes No

Have you adopted a dog from Midwest Boston Terrier Rescue before?
 Yes No

Your Occupation and Employer

(Spouse/Partner) Occupation and Employer

Does either job require frequent out of town travel?
 Yes No

Are you or your spouse/partner subject to relocation?
 Yes No

Are you a college student?  Yes No

Are you in the military?
 Yes No

Have you or any members in your household been convicted of a crime against animals?  Yes No

Personal References

Please list three personal references, not living with you. Include NAME, PHONE, & EMAIL address.

Reference 1:

Reference 2:

Reference 3:

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.

Home Information

Please select the style of your home:
 Single Family House Duplex Condo Townhouse Apartment Mobile Home Other

How long have you been at this address?

If you rent or lease, have you confirmed with the landlord that pets are allowed?
 Yes No Not Applicable, own

Please email a copy of your lease agreement to

If you rent or lease please supply the following

Landlord Name:



Phone Number:

Property Information

If your yard is fenced, please describe the area and type fence

If you do not have a fenced yard, what arrangements do you plan to make for exercise and toilet duties?

Do you have a doggie door?
 Yes No

If so, does it open into a fenced enclosure?
 Yes No Not Applicable

Do you have a pool or spa? (Required)
 Yes No

Is pool or spa fenced?
 Yes No Not Applicable

If yes, what type of fencing?

What is the activity level of your household?
 Quiet Active Moderately Active Very Active

Have all members of the household agreed to adopting a Boston Terrier?

If No or Maybe was answered above, please explain

Are any members of your household allergic to dog hair or dander?
 Yes No Not Sure

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

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)
 Yes No

Would you make the time to take your pet to participate in training/obedience, etc.?
 Yes No

If you move, what will you do with this animal?

If you have a baby, what will you do with this animal to acclimate it with the new baby?

Do you have time to exercise and play with this animal?
 Yes No

When you are not home, how will you confine your pet?

What are your thoughts to crate training as opposed to other confinement methods?

Do you understand that Boston Terriers do not tolerate extremes in temperature and are required to be indoor dogs?
 Yes No

Do you understand that Boston Terriers are high energy dogs and require a lot of exercise?
 Yes No

Do you understand that Boston Terriers can be destructive to toys, furniture, and other things? A bored dog is a destructive dog!!!
 Yes No

Do you understand Boston Terriers are people dogs and need to be with their people to maintain their happiness?
 Yes No

Do you agree to return this dog to Midwest Boston Terrier Rescue if you are unable to keep it for any reason?
 Yes No

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?
 Yes No

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.
 Yes No

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?
 Yes No

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?
 Yes No

Do you agree to have a collar and identification tags on the dog at all times, even if the pet stays indoors?
 Yes No

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?

How do you plan on getting the Boston Terrier to you?

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?

What do you like about the dog you are interested in adopting?

Would you prefer
 Male Female Either one

Would you consider a Boston Terrier Mix?
 Yes No Maybe Boston/Pug Mix Boston/Frenchie Mix Boston/Chi Mix Boston/Beagle

Have you owned a Boston Terrier Before?
 Yes No Yes, Boston Mix

Age preference
 0-7.9 yrs, $300 8yrs+, $175 Senior Boston to Senior Citizen $125

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 $300 adoption fee).

The $100 deposit will be refunded to you upon proof of spay/neuter.

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?
 Yes No

Is it important that the dog you are interested in be partially housebroken?
 Yes No

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?

How about when you are at home?

If your dog chews an inappropriate object, what will you do?

What form of discipline will you use on your dog?

What are your feelings about crate training?

Are you willing to adopt a dog with known health problems?
 Yes No

If YES, what kinds of health problems are acceptable? (Check all that apply)

 Allergies Arthritis Blindness Deafness Hair Loss Heart Disease Incontinence Limping Myelinopathy (degeneration of spinal cord) Skin Problems Three Legged Spinal Deformity Special Diet Separation Anxiety

Are you willing to adopt a dog with behavior problems?
 Yes No Maybe, depends

If so, what behavior are you willing to work with? (Check all that apply)

 Housebreaking Digging Barking Jumper Leash Training Doesn't like Dogs Doesn't like Cats Seperation anxiety Stool eatting Must be only pet Nipping Biting Door Guarding

I want my new pet to be
 Dog Friendly Cat Friendly Kid Friendly

What are you looking for in a Rescue dog regarding personality, behavior, looks, etc.?

Will your current pet(s) accept a new dog?
 Yes No Not Sure

If yes, how do you feel they will react?  Favorably Difficult Adjustment Indifferent Don't know

How would you characterize your pets behavior?
 Playful Dominant Submissive Passive Aggressive Passive Aggressive Laid back Polite Very Sociable Couch Potato Lazy Other

Where will the pet be kept during the day when you are not at home?
 Loose in entire house Confined to one room/area Crated In X-pen Loose but baby gates up Other

Where will the pet be kept at night?
 Crate in our room Crate in kids room Dog bed on floor In our bed with us Other

How long will the pet be left alone each day?
 0-2 Hours 2-4 Hours 4-6 Hours 6-8 Hours 8-10 Hours Over 10 Hours

Do you have a dog sitter or dog walker?
 Yes No Will get one

Who will be responsible for caring for this dog’s daily needs?
 Myself Myself & significant other My children Entire household Another household member Another family member Other

Have you ever had a pet get lost, die at an early age, or die in an accident?

Have you or your spouse/parter ever given up a pet?

How will you correct inappropriate behavior problems?

Exercise and elimination will be
 Exercise pen run Chain or Trolley Lead Totally enclosed fenced yard Partially fenced yard Electronic/Radio fence Loose in unfenced yard Indoor area Other

What are some of the things you enjoy most about having a pet?

Why did you choose a rescue group?

What will your first day with the dog be like?

What will you do if your dog runs away (i.e., who will you call and what will you do to get it back)?

Please list the current and past pets you have owned.
PET 1 (Name & Breed):

Pet 1 info:
 Dog Cat Male-unaltered Male-neutered Female-unaltered Female-spayed Puppy Adult Senior Currently Own No Longer Own Passed Away

PET 2 (Name & Breed):

Pet 2 info:
 Dog Cat Male-unaltered Male-neutered Female-unaltered Female-spayed Puppy Adult Senior Currently Own No Longer Own Passed Away

PET 3 (Name & Breed):

Pet 3 info:
 Dog Cat Male-unaltered Male-neutered Female-unaltered Female-spayed Puppy Adult Senior Currently Own No Longer Own Passed Away

PET 4 (Name & Breed):

Pet 4 info:
 Dog Cat Male-unaltered Male-neutered Female-unaltered Female-spayed Puppy Adult Senior Currently Own No Longer Own Passed Away

PET 5 (Name & Breed):

Pet 5 info:
 Dog Cat Male-unaltered Male-neutered Female-unaltered Female-spayed Puppy Adult Senior Currently Own No Longer Own Passed Away

If you need additional space for pets, use "Additional Comments" area at end of this application.

If you no longer own the pet, why?

Have you filled out an adoption application with any other rescue or organization?
 Yes No

If yes, to whom have you applied to and when?

Have you adopted a dog from a Rescue or Shelter in the past?
 Yes No

If so, from whom and when did you adopt?

When transporting your dog, what form of transportation do you use?
 Loose in Car/Truck On lap in Car/Truck Seatbelt Crate Harness

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:

Veterinarian Name:


Telephone Number:

What yearly costs do you expect for the standard care and maintenance of your pet(s)? (i.e. shots, exams, food, etc.)

In the event of a medical emergency, what kind of costs are you prepared to handle?

In the event you or another household member lost your job, are you financially prepared to afford the expense of owning this new dog?

What heartworm preventative do you and/or your Veterinarian use:

RELEASE for veterinary reference: 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).

Electronically signed by (required):

My current veterinarian is: , and can be reached at (telephone) or (address)

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

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?
 Yes No

Are you willing to wait this long?
 Yes No


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.

CLICK HERE, to go to our homepage. Then click on the big red DONATE button on the right hand side to make a payment.

How will you be submitting your $20 Application Fee?  Online via PayPal Check mailed via USPS N/A, I'm a previous MWBTR Adopter

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):

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):

Add any additional comments that you'd like us to know more about here

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:

Please make sure you also submit $20 application fee.


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