Border Terrier Rescue Adoption Application
Please complete the following application. Additionally, mention which dog you are interested in or describe your perfect dog. We want to place the right dog with you!
Please make sure to complete the required areas noted so that we may contact you with further information. The application cannot be processed without this information.
If you would prefer, print out the application and email it to email@example.com or send it to:
Annette Neff 5200 Harlem Road Galena, Ohio 43021.
Name: _________________________________________________ * required
Email Address: _____________________________
Phone Number: ____________________ ___________________* required
Age ______ Occupation ______________________________
Best time to contact: ______ AM ______ PM
Mailing Address: ______________________________________________* required
Residence situation: ______Acreage ______ City ______ Suburban Neighborhood ______ Condo ______ Apartment
______ Own ______ Rent ______ Number of years at current residence
If you rent, do you have permission from your landlord to have a dog? _______
Name and telephone number of landlord: _____________________________
Do you have a fenced yard? _______ Describe Type: __________________________
Height of fence: ________ft. Dimensions of Dog Area: ________________________
If you do not have a fenced yard, how will you keep your dog confined and safe?
List the members of your human household including frequent visitors and their ages:
Is anyone in your household including frequent visitors allergic to dogs? _______
What are your grooming expectations? _____________________________________
What do you know about border Terriers? What qualities appeal to you?
Are you aware that Borders do shed and otherwise pose a clean house challenge with muddy footprints, etc? ____________________________________________
What kind of temperament would best suit your household? _________________________________________________________________
Name of the person who is the primary care taker for this dog: ____________________
Hours the dog would be alone daily: ________
Where will the dog stay when you are at work or out of the house? _________________
Where will the dog sleep? _______________________________________________
Where will the dog stay when you are not at home? ____________________________
What activities would you like to share with your dog? __________________________
What will you do to protect your dog from getting lost? __________________________
What dollar amount do you expect to spend to take care of a dog annually? ___________
How will you obedience train the dog? ______________________________________
How will the dog be taken care of when you are away on business or vacation?
Which dog or dogs interested you on our site: ________________________________
Are you interested in a: _____ Male _____ Female _____ No Preference
Select as many as apply: Are you interested in a _____ puppy _____ young adult
_____ or older animal _____ animal with special needs
Would you consider adopting a Border Terrier mix? ______ Yes ______ No
How far would you be willing to travel to adopt a rescue?
_____ Within 100 miles of my home ____ within my state _____ adjacent states
Current Pet Ownership
Do you currently own or live with any other animals? _____
If yes, what type, spayed/neutered, and age are these animals? ________________________________________________________________
If any of your current animals have medical conditions, please explain:
Who is your current vet? (Name and telephone number)
Who is your current groomer? (Name and telephone number)
Are your animals up to date on their shots and vaccines? __________
What brand of dog food do you feed? ______________________________________
What brand of heartworm preventative do you use? ____________________________
What brand of flea and tick preventative do you use? ___________________________
Under what circumstances would you give up a dog? ____________________________
If you have a one cat/dog household, does your cat/dog get along with other dogs?
Have you ever given up a dog? If you have, please explain why?
Describe previous dogs you have owned, how long they lived and what ultimately happened to them? ___________________________________________________________
Have you ever adopted a dog from any rescue group before? If yes, please identify breed and rescue group: ____________________________________________________
List a personal reference who does not live with you:
Name and telephone number: ____________________________________________
Do you consent to home visits before and after the adoption? _______
Use the space below if you have any questions or comments for us:
By signing this application you acknowledge that you are aware that if you cannot keep the Border Terrier you agree that it MUST be returned to the Border Terrier Rescue Group.
You will be asked to make a financial donation to the Border Terrier Rescue Group to defray the expenses of rescuing the dog, such as vet care, grooming and shelter fees? (This may be up to $300.) Home visits will be conducted prior and following an adoption to ensure the safe keeping of the dog. The Border Terrier Rescue Group reserves the right to decline adoption or reclaim any dog that in our judgment appears abused, unkempt or unsafe or non-payment of adoption fee at any time. Thanks for your help and interest in placing a homeless Border Terrier.
I certify that the information provided on this form is true and accurate. I am physically, emotionally and financially able to care for a Border Terrier. I understand that proper food and veterinarian care can be costly and I am able to meet these requirements.
Name Signature Date