to...Achates Bostons, LLC.
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Ch Bleugras Jolie`Of Buena Vista, CGC, ROM*



Achates Boston Terriers



Susan LeCalsey

4125 Dollar Lane

DePere WI 54115

Home  920-339-9449  FAX   920-339-9452   Cell 920-246-0050







Each and every prospective puppy buyer is asked to fill out this questionnaire with honesty and openness, and then sign and return it. This will help me to determine whether a Boston Terrier is well suited for you and your lifestyle, as well as help me determine what traits you are seeking in a Boston Terrier puppy.

Name: _____________________________________________________________________________

Address: _____________________________________________________________________________


Phone Number: _______________________ E-Mail Address: ____________________________

If you have a P.O. address, please give street address as well.

How did you hear about Achates Boston Terriers? _____________________________________________________________________________


Are you interested in a Puppy ____ Adolescent ____ or Adult Dog? ____(Check all that apply)


Would you be interested in a Rescue Dog if one was available that met your needs?

Yes____ No____


Will this be your first Boston Terrier? Yes ____ No ____


If Yes, have you researched the Boston Terrier breed? Yes ____ No____


What kind of research was done? Pick all that apply:

____ Web site Searches ____ Television ____ Magazines

____ Friends/Family ____ Movies ____ Breeders

____ Books ____Dog Shows ____ Exhibitors

____ Other ____________________________________________________________________________

If you have had a Boston before, please list the registered names of each and how they were acquired: ____________________________________________________________________________




Please list names/species/breeds of other pets you have previously owned. If they died, list the age and what they died from. Or did you have to sell, place or give them away?

____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________


If you currently have other pets, please list their Breed, age, sex and whether they are intact or spayed/neutered? ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________


Do you: Rent an apartment ____ or Do you own a condo/home? ____


If you rent, has your Landlord given you permission to purchase a Boston? Yes ____ No ____


Please provide Landlord’s Name and Phone Number: ____________________________________________________________________________


Describe your yard or prospective exercise area: ____________________________________________________________________________

____________________________________________________________________________ ____________________________________________________________________________


Is your yard fenced and is it secure that a puppy can not escape? Yes ____ No ____


If yes, please tell me what type of fence and how tall it is: ____________________________________________________________________________


List the names, ages and relationship of those who reside with you: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________


Are you planning on having cny children in the next 5 years? ____________________________________________________________________________


Is everyone in your household in agreement with getting a new Boston Terrier? Yes ____ No____

If No, please explain: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________


Who will be the primary care giver to this new Boston? ____________________________________________________________________________



Do you agree that it is in the best interest of your new puppy to take it to at least a puppy kindergarten/beginners obedience class, and will you show me proof of graduation?



Will you agree to feed only a Premium Quality Dog Food that does not contain Brewers Yeast and stay away from all Grocery Store Brands of food, keeping your dog in proper weight at all stages of its life? Yes ____ No ____


Will you agree to follow my recommendations on puppy vaccinations and do a first year booster and then bi-annual titer checks or bi-annual Boosters? Yes ____ No ____

(You and your Veterinarian can decide which course is best for your dog)


Will you agree to take your new puppy to the Vet whenever he/she shows signs of illness, lameness or pain? Yes ____ No ____


Are you aware of the prevalent health issues in Boston Terriers? (such as deafness, cataracts, bad patellas, cardiac problems, etc…) Yes ____ No ____


Will you promise to keep me informed of any health or medical conditions that occur with your puppy whether good or bad? Yes ____ No ____


Please explain how you will ensure the safety of this puppy while you are at work or away from your home and the puppy is alone? ____________________________________________________________________________



Will you agree to confine your puppy to a crate, indoor exercise pen or puppy proofed room so that he/she is protected from eating inanimate objects when you are not supervising him/her until he/she can be trusted? ____________________________________________________________________________




Will someone be available to walk your dog during the periods you are away from your home to work? Yes ____ No ____ If so, who?: ____________________________________________________________________________


If not, will you agree not to crate your Puppy for more than 4 consecutive hours at a time and not to exceed more than 10 hours total within a period of 24 hours? Yes ____ No ____


Do you promise to have short designated Play Periods each and every day with your puppy and to follow my advice on what is appropriate play exercise? Yes ____ No ____ If No, explain: ____________________________________________________________________________



Do you promise to restrict any stair climbing to only times when the puppy is in your immediate supervision until after it is 12 months of age? Yes ____ No ____


Do you agree to not let your puppy run and play on slick surfaces such as linoleum flooring, ice, etc… on a day to day basis until it is over 24 months of age? Yes _____ No ____


Where will your puppy sleep at night and what type of bedding will it have? ____________________________________________________________________________



Will you agree to only use positive reinforcement in your training methods with this puppy?

Yes ____ No ____ If No, explain: ____________________________________________________________________________


Which member of your family will be primarily involved in the training of your puppy? ____________________________________________________________________________


Will you agree to keep your puppy clean by brushing, bathing, cleaning ears and teeth and by keeping nails trimmed on a weekly basis? Yes ____ No ____


Will you agree to never let your dog ride in the back of an open pick up truck or open bowed boat?   Yes ____ No ____


Will you take extra precautions so that your puppy will never be left in a car during warm weather as temperatures can rise to dangerous levels very quickly so the dog will not die from heat exhaustion?   Yes ___ No ____ I have had one of my Boston's die from this on a cool day while the owner was away from the car for just a few minutes.  You must use EXTREME caution!


Do you agree to take your puppy with you after it has completed it series of shots, to public areas such as parks, Petco, shopping malls, etc….. for continuing socialization of the puppy until she/he is at least 24 months old? Yes ____ No ____


Do you have a preference as to what sex puppy you would like and why? ____________________________________________________________________________________




Are you looking for a Pet/Companion or a Show Quality puppy? ____________________________________________________________________________________


What is your favorite pass time activity? ____________________________________________________________________________________



If purchasing a pet will you promise to spay/neuter your puppy at the age of 1 year, providing a Certificate of Verification of Spay/Neuter to me from your Vet?   Yes ____ No ____ If no explain: ____________________________________________________________________________________



If you are requesting a Show Quality Puppy, you must agree to do the following Health Testing: Cerf Eye Exam, annually and the Patella Exam, bi-annually? Yes ____ No ____


Are you financially secure that you can take on the added expenses of showing this puppy until it becomes a Champion by paying for entry fees, handling fees and transportation expenses to the shows? Yes ____ No ____ If No, explain: ____________________________________________________________________________________



What kind of temperament and personality are you looking for in this puppy? ____________________________________________________________________________________

If purchasing a show potential puppy, what specific characteristics are most important to you in this puppy? ____________________________________________________________________________________




Please provide the name and address of your Current and past Veterinarians that have provided care for you animals and by doing so you grant me permission to call and acquire a reference from them as to your previous medical care provided to your pets:


Vets Name: __________________________________________________________________


Pet’s Name:________________________________


Clinic Name:___________________________________________________________________


Address: _____________________________________________________________________


Phone Number:________________________________________________________________


Please use the reverse side of this page if you need to list additional Veterinarians and Clinics.


Please list the name and Phone numbers of 2 other references who can vouch for how you take care of your animals and by providing names you grant me permission to call them for a character reference:


Name: ______________________________________________________________________

Phone: _______________________________  E-mail address:_________________________

Best time to contact them: ______________________________________________________ 


Name: ______________________________________________________________________

Phone: _______________________________  E-mail address:_________________________

Best time to contact them: ______________________________________________________



You agree to always keep me informed of any phone and address changes for purposes of animal recovery should your new puppy be lost or stolen. Your puppy has been micro-chipped by the AVID System and is registered in my name. Upon purchase, my name will be moved to the 2nd place with your name and contact info as the primary contact person.  Yes ____ No ____


You agree that if you purchase a puppy from me that you will never be able to sell it to someone else and that my name will always appear on its AKC Registration papers as co-owner? Yes _____


If for any reason you are unable to keep this puppy for the remainder of its life, it must be returned to me with you paying all shipping expenses to return puppy. Puppy can not be sold, placed or given away to anyone other than myself. I will provide a home for him/her or place it in the appropriate home at no charge to the new owner. No puppy will ever be sold a second time like a piece of used furniture. No monies will be refunded to the original purchaser. This puppy may not be euthanized

for any reason without my consent. I am available 24/7 in an emergency.


I agree to the above paragraph. Signature of prospective owner: ____________________________________________________________________________


If you reside a fair distance from me, would you agree to have a home visit performed by a qualified Boston Terrier person who lives in your area? I may ask them to bring one of their Boston Terriers with them so you can see how a puppy would interact in your home and yard.

I agree: _____ No, I would not allow a visit from a fellow Boston Terrier person. _____


I have completed this questionnaire to the best of my ability and I have answered the questions truthfully and honestly. If I am allowed to purchase a Boston Terrier from Achates Boston Terriers, I promise to always keep the best interest of this animal at heart in the day to day decisions that I make, that may affect its life and well being.


Signed by applicant: ___________________________________________________________


Date: ______________________________


Signatures of other household members in agreement of adding this Boston to your family:





If you purchase a puppy from me, you will always be able to contact me for help in any questions that you may have concerning the care and health of your new puppy.


You may complete this questionnaire and return it to me by e-mail, fax or "snail mail". Just delete the lines I provided for you to write on and type in your answers in a contrasting color.


Where a signature is required, TYPE: "I do" or "I Do Not Agree" and your name which serves as your electronic signature.


If you take great care of my puppy, I will be your friend for life.


Susan LeCalsey

Achates Boston Terriers