Adoption Application Form

Westie Rescue Adoption Application Form

APPLICANT

* Indicates required field

Name *

First

Last

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone *

Work Phone *

Cell Phone *

Applicant's Occupation *

CO-APPLICANT

Co-Applicant *

First

Last

Relation to Applicant *

Co-Applicant's Occupation *

DESIRED WESTIE

Gender - Choose One *

Male Female No Preference

Are you willing to housetrain? *

Yes No

Age Desired *

(Dogs under 3 years old are seldom turned in for rescue)

YOUR HOME

Do you own or rent? *

Own Rent

Type of home? *

How long at address? *

Renters: Are you willing to provide a copy of your lease or a notarized statement from your landlord authorizing you to keep a dog? *

Yes No

Do you have a completely fenced yard area for the dog? *

Yes No

What kind of fence is it? *

Do you have a pool or hot tub? *

Yes No

Is it separated from the dog area by a fence? *

Yes No

How often do you plan on exercising the dog? *

How many adults live in your home? *

How many children? *

List ages of children: *

Who will be the dog's primary caretaker? *

Does he/she have experience with dogs? *

Yes No

Is anyone home in this person's absence? *

Yes No

Is this person capable of exercising the dog? *

Yes No

How long will the dog be without humans daily? *

How long will the dog be alone during evenings? *

Where will the dog be housed while alone? *

Where will the dog sleep at night? *

Is anyone in your household allergic to dogs? *

Yes No

Does anyone in your household have asthma? *

Yes No

Does your job require frequent out of town travel? *

Yes No

Who will care for your dog when you are out of town? *

Are you subject to relocation? *

Yes No

What would you do with the dog if you moved? *

WESTIE CARE AND COMMITMENT

For a healthy dog, costs of veterinary care (shots and flea and heartworm preventative), food, toys, and minimal boarding and grooming can cost $500-$700 per year. In addition, dogs are susceptible to most diseases that afflict humans such as allergies, cancer, heart disease, arthritis, etc.

Are you prepared to provide medical treatment for such problems as needed? Westies can live 15 to 20 years *

Yes No

Are you prepared to commit to a Westie for his entire life? *

Yes No

We require all Westies to be altered before adoption. Are you opposed to spaying or neutering dogs? *

Yes No

YOUR PET EXPERIENCE

Do you currently own a Westie? *

Yes No

If yes, what is his/her name? *

Have you ever owned a terrier? *

Yes No

What kind? *

Please list all the pets you have owned in the past 10 years. If none, include pets you have owned during your adult life and any pets residing in your home that you do not own.

Species - Breed - Gender - Altered - Where it is now? *

If you ever had a pet that died at early age, became lost or disappeared, please explain the circumstances (dog less than 10 years and cat before 14 years): *

Have you ever sold, given away or surrendered a pet to a shelter? If yes, please explain the circumstances: *

If you presently have a dog, is it on vaccinations? At minimum; rabies, distemper, hepatitis, parvovirus, and parainfluenza and heartworm preventative. If no, please explain: *

If you presently have a dog, where is it housed? *

Other than housetraining, have you ever trained a dog? *

Yes No

If yes, what type of training? *

Personal References (not related to you)

Name - Reference #1 *

Name - Reference #2 *

Name - Reference #3 *

Easiest time to reach Ref. #1 *

Easiest time reach Ref.#2 *

Easiest time to reach Ref.#3 *

Relationship to Ref. #1 *

Relationship to Ref.#2 *

Relationship to Ref.#3 *

Phone Number *

Intended Veterinarian *

Hospital Name *

Phone Number of Hospital *

Address of Hospital *

Line 1

Line 2

City

State

Zip Code

Country

ACKNOWLEGEMENT

The information I have provided in this application is true and complete. I understand that any misrepresentation of facts may result in removal, by Westie Rescue, any dog adopted from them.
By typing your name in the box below, you are electronically signing the document in agreement with the above.

Name: Electronic Signature *

Initials *

Date *

Is this vet familiar with other pets you have owned? *

Yes No

May we contact this vet as a reference? *

Yes No

Submit