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Westie Rescue Adoption Application Form
APPLICANT
Name
*
First
Last
Age
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Home Phone (Optional)
*
Work Phone (Optional)
*
Cell Phone
*
Email
*
CO-APPLICANT
(Optional)
Co-Applicant
*
First
Last
Age
*
Relation
*
Applicant's Occupation:
*
Co-Applicant's Occupation
*
DESIRED WESTIE
Gender - Choose One
*
Male
Female
Are you willing to housetrain?
*
Yes
No
Age Desired
*
(Dogs under 3 years old are seldom turned in for rescue)
Why do you want a Westie? Check all that apply.
*
Companion for humans
Campanion for another pet
For protection
To give as a gift
To breed
For children
YOUR HOME
Where do you live?
*
Type of home?
*
How long have you resided at this 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
If yes, 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 live in your home?
*
List ages of children:
*
Who will be the dog's primary caretaker?
*
Does the primary caretaker have experience with dogs?
*
Yes
No
Is anyone home in the primary caretaker's absence?
*
Yes
No
Is the secondary caretaker 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 & 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?
*
Yes
No
Westies can live 15 to 20 years. 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
If yes, 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.
Any particular species? Breeds? Genders? Ages? Were they fixed? Where are your pets 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 vaccinated? If no, please explain:
*
At a medical minimum, please select the medical provisions that you are providing for your pet with a veterinarian.
*
Rabies
Distemper
Hepatitis
Parvovirus
Parainfluenza
Heartworm Preventative
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
*
Phone Number
*
Phone Number
*
Intended Veterinarian
*
Hospital Name
*
Phone Number of Hospital
*
Address of Hospital
*
Line 1
Line 2
City
State
Zip Code
Country
Is this vet familiar with other pets you have owned?
*
Yes
No
May we contact this doctor as a reference?
*
Yes
No
ACKNOWLEGEMENT
The information I have provided in this application is true and complete. I understand that any misrepresentation of facts may result in removal of any dog adopted from the Westie Rescue of Western PA by the Westie Rescue of Western PA.
By typing your name in the box below, you are electronically signing the document in agreement with the above.
Initials for Consent
*
Date
*
Because of the high volume of applications received, incomplete applications may be delayed.
Submit
Home
About Us
Adopt/Surrender A Westie
Up For Adoption
Adopted Westies
Westie Facts
Behavior Training
Rescue Tails
Events
Become a Rescuer
Become a Foster
Donate
Photos
