Name: * required
Address: * required
City: * required
Province/State:
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
Washington DC
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
North West Territories
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
* required
Postal Code/Zip: * required
Phone: * required
Email: * required
The following questions are not intended to be critical or judgmental.
The answers will help us in placing a Border Terrier with you.
It may even help us and you to realize that a Border Terrier is not the right breed for you.
When we place a dog in a new home we want the placement to be a happy situation for you and your family as well as the dog.
We also want the placement to be a permanent placement for the life of the dog (Border Terriers can live 13-18 years).
Please answer all of the questions before submitting the form.
There are no wrong answers so please answer honestly.
Home Environment
Age: Occupation:
Best time to contact: A.M. P.M.
How would you describe your location
Rural/Country:
Suburban Neighbourhood:
Urban
How would you describe your residence
House:
Apartment/Condominium
Do you rent or own
If you rent, do you have permission from your landlord to have a dog? :
(Please enter the name and phone number for your landlord: )
Do you have a fenced yard?
Yes
No
If the answer to the above is "Yes", please describe the type of fencing, height and the size of the dog area
If the answer to the above is "No", please describe how will you keep your dog confined and safe?
Please list the members of your human household including frequent visitors, their relationship to you 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? What sources of information did you use to learn about the breed?
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?
Who will be the primary caregiver for your Border Terrier?
Hours the dog would be alone daily:
Where would you leave the dog while you were out of the home? (you may select more than one answer):
Free run of the house
Confined to part of the house
Crate
Other
Please specify
Where will the dog sleep:
What plans do you have for your dog when you go on vacation or are away from home
Which, if any, of the following activities would you like to share with your dog? (check as many as you like):
Eathdog Tests
Hunting
Obedience
Rally
Therapy
Tracking
Agility
Flyball
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?
Is it important to you to walk with your dog off leash?
Yes
No
Dog Preference
Which dog or dogs interest you on our site:
Do you have a strong preference for male or female?
Male
Female
No Preference
If you have a preference, please explain why.
We very rarely get puppies into rescue, mature adults and sometimes seniors are more likely.
Keeping in mind that many Border Terriers remain active into their teens, please indicate what age group you would prefer (you may select more than one age group):
Puppy
Young Adult
Mature Adult
Senior
Dog with special needs (may be health or personality related)
Would you consider adopting a Border Terrier mix?
Yes
No
How far would you be willing to travel to adopt a rescue?
Pet Information, past and present
Have you lived with or personally owned a Border Terrier before?
Yes
No
Do you currently own or live with any other animals?
Yes
No
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)
What vaccinations do you give your dogs and how often?
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?
Please provide information on any dogs you have owned in the past and the circumstances under which they left your household.
Have you ever adopted a dog from any rescue group before? If yes, please identify breed and rescue group:
References and Additional Information
List a personal reference who does not live with you: Name and telephone number:
Are you willing to have a NABTW representative or delegate visit your home?
Yes
No
Adoption fees vary depending on the age of the dog and the circumstances and may range from $0 to $350.
Are you willing and able to pay an adoption fee?
Yes
No
Please use the space below if there is anything else you would like to tell us or if you have any questions or comments for us: