Westie Rescue Adoption Application

Westie Rescue Adoption Application Form

This is an application for Adoption Volunteering Foster Home Adoption and Volunteering
If you are filling this out for Adoption and Foster home, please fill out all blanks you are able to.
Some questions may not be applicable if you are applying for volunteering only.

Name of dog(s) and/or breed of dog you are interested in:

Applicant

First Name Last Name Age

Street (incl. Apt.)

City State Zip

Day Time Phone Evening Phone Email

Co-Applicant

First Name Last Name Age

Relation Spouse Parent/Guardian Roommate Other

Applicant's Occupation

Co-Applicant's Occupation

Adoption Preferences

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 minor children in your home?

List Ages of Children in your home

Who will be the dog's primary caretaker?

Does the primary caretaker have experience with dogs?
Yes No

Is anyone home when the primary caretaker is absent?
Yes No

Is the primary 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?
Crated
Loose in the House
Room Confined
Yard
Other Explain

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?

Pet 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 $300-$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

Small dogs can live 15 to 20 years. Are you prepared to commit to a dog for his entire life?
Yes No

We require all dogs to be altered before adoption. Are you opposed to spaying or neutering dogs?
Yes No

Your Pet Experience

Please list all the pets currently residing in your home and all pets you have owned in the past 10 years.
If none, include pets you have owned during your adult life.

Species (cat,dog, etc)

Breed

Gender

Age

Altered?

Where is it now?

Yes
No

If you ever had pets that died at early age or from unusual circumstances, became lost or disappeared, please explain the
circumstances (dog less than 10 years and cat before 14 years).

Have you ever sold a pet, given one away or surrendered a pet to a shelter or rescue group?
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 Inside and Outside

Other than housetraining, have you ever trained a dog? Yes No

If Yes, what type of training?

Personal References

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

Phone Street 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

Additional information:

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.
Signature (type name if submitting via internet)
Date
For your own records, you may want to print this form before submitting.
Submit form by clicking link below or print form and mail it to:
Kathy McGullion
Westie Rescue
PO Box 683
Tomball, TX 77377-0683

Westie Rescue Houston Home Page
Contact Us (Donations, Follow up, etc.)
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