Westie Rescue Adoption Application Form

Please note that hitting the "Enter" or "Return" key will submit the form. Use the "Tab" key or your mouse to navigate from one field to the next.


Applicant
First Name   Last Name    Age
Address
Street (incl. Apt.)
City   State   PostalCode
Home Phone    Work Phone    Cell Phone
Email
 

Co-Applicant
First Name   Last Name   Age
Relation    Spouse Parent/Guardian Roommate Other
Applicant's Occupation
Co-Applicant's Occupation
 

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. I understand that any misrepresentation of facts may result in removal by Westie Rescue of any dog adopted from them.

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

Date      

Because of the high volume of applications received, consideration of incomplete applications may be delayed.