Adoption Form

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Applicant

First Name Last Name Age

Address

Street (incl. Apt.)

City State PostalCode

Phone Email

Desired Westie
Gender No Pref. Prefer Female Require Female Prefer Male Require Male
Are you willing to housetrain? Yes No
Age (Dogs under 3 years of age are seldom turned in for rescue.) No Preference Prefer 1-3 yrs Require 1-3 yrs Prefer 4-6 yrs Require 4-6 yrs Prefer 6+ yrs Require 6+ yrs	Why do you want a Westie? (Check all that apply.) Companion for humans Companion for another pet For protection To give as a gift To breed For children

Your Home
Where do you live? I own I rent How long at address?	Type of Home Apartment Condo Townhouse House Other
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 N/A
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 fence? Yes No
How do you plan to exercise the dog?
How many adults live in your house?
How many children?	List Ages of Children
Who will be the dog's primary caretaker?	Does he or 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? Crated Loose in the House Room Confined Yard	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 the 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? 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? If yes, what is his/her name?			Have you ever owned a terrier? 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	Age	Altered?	Where is it now?
				Yes No
				Yes No
				Yes No
				Yes No
				Yes No
				Yes No
				Yes No
				Yes No
				Yes No
				Yes No
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 current on vaccinations? At minimum rabies, distemper, hepatitis, parvovirus, and parainfluenza and on heartworm preventative. Yes No
If no, please explain.
If you presently have a dog, where is it housed? Inside Outside Both
Other than housetraining, have you ever trained a dog? Yes No
If Yes, what type of training?

Personal References (not related to you)
Reference 1
Name Easiest time to reach
Relationship (neighbor, co-worker, etc.) Home Phone
Reference 2
Name Easiest time to reach
Relationship (neighbor, co-worker, etc.) Home Phone
Reference 3
Name Easiest time to reach
Relationship (neighbor, co-worker, etc.) Home Phone

Intended Veterinarian
Name of the Doctor	Hospital Name
Home Phone Address
City State Zip
Is this veterinarian familiar with pets you have owned? Yes No
May we contact this doctor as a reference? Yes No

The information I have provided in this application is true and complete.

For your own records, you may want to print this form before submitting.

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