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Central Ohio Westie Rescue Adoption Application - - - Today.s Date_________________________________________________________________________________________ Applicant(s): ________________________________________ If you are interested in a specific Westie, please list his/her name here.Prospective Owner: Last Name: ___________________________ First Name: ____________________ Age: _________ Address: _________________________________________________________________________ Street ( Include Apartment Number) City State Zip CodePhone: (_____)____________________ Home E-mail: __________________________________ (_____)____________________ Work Cell Phone: (_____)_________________________ Employer/Occupation: _______________________________________________________________ Prospective Co-Owner: Relationship to Prospective Owner: __Spouse __Partner __Parent __Child __Roommate __Other (_______)Last Name: ______________________________ First Name: ____________________ Age: ______ Address: _________________________________________________________________________ Street (Include Apartment Number) City State Zip CodePhone: (_____)___________________ Home E-mail: __________________________________ (_____)___________________ Work Cell Phone: (_____)_________________________ Employer/Occupation: _______________________________________________________________ Please let us know your reasons for wanting to obtain a .rescued. Westie: ________________________________________________________________________________ ________________________________________________________________________________ Desired Westie :Gender: __ No Preference __ Prefer a Female __ Prefer a Male__ Must Have a Female __ Must Have a Male Age: Please keep in mind that dogs under three years of age are rarely turned in for rescue and that your chances of adopting is greatest if you will consider an older Westie or a Westie with a minor health issue. Choose one of the following: __ No Preference __ Must Have __ PreferIndicate all that you would conside r: __ Baby __ Age 1-3 __ Age 4-6 __ Age 7-9 __ Age 10+Would you consider adopting a Westie mix? ___ Yes ___ No, we really want a WestieAre you willing to housetrain or retrain if necessary? ___ Yes ___ NoWould you be willing to consider adopting a Westie with a .minor. health issue? __ Yes __ NoWould you be wiling to foster a rescued Westie? ___Yes ___ NoPage 1 of 5 Central Ohio Westie Rescue ADOPTION APPLICATION (cont.d) Residence: Where do you live? __Single Family Home __Duplex __Apartment __Condo __Farm __Live with family (parents/other relative)Status: __Own __Rent/Lease __Temporary Residence (please give reason) ________________________________How long at this address: ____ years (if under 2 years, please give prior address and how long at that address)____________________________________________________________________________________________________ Are you willing to provide a copy of your lease/association agreement showing you are permitted to have a dog? ___yes ___no If no, please explain: _____________________________________________ Does anyone in your household smoke inside your home? ___yes ___no Do you have a securely fenced in yard or area for the dog? ___yes ___no ___in process What kind of a fence or area is it/will it be? _________________________________________ Do you have a swimming pool or hot tub? ___yes ___no If yes, is it separated from the dog area by a secure fence? ___yes ___no How will you exercise the dog? _________________________________________________________ How will you discipline the dog? ________________________________________________________ How many adults live in the household? ____ How many children? _____ Ages: ____________________ Do you have children who visit frequently? __yes __no If yes, ages & how often: __________________ Who will be the dog.s primary caretaker? _________________________________________________ Does he/she have experience with dogs? ___yes ___no Explain: _____________________________ __________________________________________________________________________ __________________________________________________________________________ Is anyone home in this person.s absence? ___yes ___no Who?_______________________________ Does this person have experience with dogs? ___yes ___no Explain: ____________________ __________________________________________________________________________ Is this person capable of exercising the dog? ___yes ___no Explain: ___________________ __________________________________________________________________________ How long will the dog be without humans on weekdays/workdays? ______________________________ How long will the dog be without humans on weekends/days off? ________________________________ Where will the dog be kept while home alone? (check all that may apply) ___Crate ___Loose in the house ___Confined to a room ___In a penned area inside ___In a fenced in yard ___Other (____________) Explain: __________________________________________________________________________ Where or with whom will the dog sleep? __________________________________________________ Is anyone in your household allergic to dogs? ___yes ___no If yes, who? _____________________ Does anyone in your household have Asthma? ___yes ___no If yes, who? _____________________ Page 2 of 5 Central Ohio Westie Rescue ADOPTION APPLICATION (cont.d) 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? _____________________________________________ Who would you want to have the dog if you died? ___________________________________________ It is our goal to find the best possible home for our rescues. Because of this, it is not a .first come, first serve. process. Although we get dogs in on a regular basis, you may need to be patient to find the Westie that is a good match for you and your family. How long would you be willing to wait for a rescue to adopt? __________________________________________________________________________ How Did You Hear About Us? ________________________________________________________________________________ ________________________________________________________________________________ Care: Even for a healthy dog, basic costs of veterinary care (shots, flea and heartworm preventative, food, toys, and minimal grooming and boarding) can cost $800 or more per year. In addition, dogs are susceptible to most diseases that afflict humans such as allergies, diabetes, cancer, heart disease, arthritis, etc. (Westies are especially prone to skin allergies) These conditions can be expensive to treat properly. Are you financially & emotionally prepared to provide proper medical/dental treatment for the life of the Westie? ___yes ___no ___not sure Explain: ________________________________________ ________________________________________________________________________________ Westies can live to be 15-20 years old. Are you prepared to commit to a rescued Westie for his/her entire life? ___yes ___no ___not sure Explain: _____________________________________________ If you could no longer keep the Westie you adopt, or if you are considering euthanizing the dog for ANY reason, would you agree to notify us (Westie Rescue) first? ___yes ___no If no, please explain: ________________________________________________________________________________ We require that all Westies be altered (spayed or neutered). Are you opposed to the spaying or neuteringof dogs? ___yes ___no If yes, please explain: __________________________________________ Pet Experience: Please list all the pets you have owned. If none, list pets you grew up with in your parents home and any pets that have resided in your residence that you do/did not own. Age Is he/she still with you? Species (dog/cat, etc) Breed Gender now or Altered? If no, where is he/she now?at death ______________ ________________ __M __F _____ __Yes __No __________________ ______________ ________________ __M __F _____ __Yes __No __________________ ______________ ________________ __M __F _____ __Yes __No __________________ ______________ ________________ __M __F _____ __Yes __No __________________ ______________ ________________ __M __F _____ __Yes __No __________________ ______________ ________________ __M __F _____ __Yes __No __________________ ______________ ________________ __M __F _____ __Yes __No __________________ page 3 of 5 Central Ohio Westie Rescue ADOPTION APPLICATION (cont.d) Have you ever had a pet that died at an early age, became lost, stolen or disappeared? ___yes ___no If yes, please indicate which and explain the circumstances: _____________________________ __________________________________________________________________________ Have you ever sold, given away or surrendered a pet? ___yes ___no If yes, please indicate which and explain the circumstances: _____________________________ __________________________________________________________________________ Is your present dog (or were your past dogs), current on vaccinations? (At minimum, rabies, distemper, hepatitis, parvovirus and parainfluenza) ___yes ___no ___ not sure If no or not sure, please explain: _________________________________________________ __________________________________________________________________________ Is your present dog (or were your past dogs), up to date on his/her heartworm preventative? ___yes ___no ___ not sure If no or not sure, please explain: _______________________________ ________________________________________________________________________________ If your adopted Westie becomes terminally ill or dies will you agree to notify WOOF as soon as possible? ___ yes ___ no If you presently have a dog, where is it housed? ___inside __outside __ garage ___other (__________) Other than housetraining, have you ever trained a dog? ___yes ___no If yes, what type of training? ____________________________________________________ ________________________________________________________________________________ Donation: We will request that you reimburse us for medical & miscellaneous expenses incurred for the careprovided to the Westie you adopt . We will also ask for a donation to help with our rescue program. Thisdonation will range anywhere from $0 to $500 depending on the age, health and quality of the Westie. 100% of your donation will be used to help other Westies that we rescue. Will this keep you from adopting? __yes __ no If yes, please explain your circumstances and provide the maximum amount you could spend obtaining a dog: ____________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Personal References (not related to you)1. Name: ______________________________________ Relationship: ________________________ Phone number: _____________________ Best time to reach them: ___________________________ 2. Name: ______________________________________ Relationship: _______________________ Phone number: ______________________ Best time to reach them: __________________________ 3. Name: ______________________________________ Relationship: ________________________ Phone number: _____________________ Best time to reach them: ___________________________ page 4 of 5 Central Ohio Westie Rescue ADOPTION APPLICATION (cont.d) Intended Veterinarian (we can recommend a vet in the Central Ohio area if you do not already have one)Name of Doctor ______________________ Hospital Name _________________________________ Phone: (_____) _______________ Address:____________________________________________ City: _______________________ State: ______ Zip: __________ Fax: (_____) _______________ Is this veterinarian familiar with the pets you own or have owned in the past? ___ yes ___ no May we contact this veterinarian for a reference? ___ yes ___ no Intended Groomer (we can recommend a groomer in the Central Ohio area if you do not already have one)Business Name______________________________ Groomer.s Name ________________________ Phone: (_____) ____________________________ Fax (_____) ____________________________ Street Address: ___________________________________________________________________ City: ________________________________________ State: ___________ Zip: _____________ Is this groomer familiar with the pets you have owned? ___ yes ___ no May we contact this groomer for a reference? ___ yes ___ no AFFIDAVIT: The information I have provided in this application is accurate and complete. I understand that any misrepresentation of facts will result in immediate rejection of my/our application. _____________________________________________ _________________________ Signature Date _____________________________________________ _________________________ Signature Date There is a $10 non-refundable application fee. Please make your $10 check payable to .Central Ohio Westie Rescue. **** Please date your application (top left of 1 st page) ****Mail the completed form along with your check to: Beverly Ressler Central Ohio Westie Rescue 670 White Tail Drive Columbus, Ohio 43230 Three to four days after you mail the application please call Beverly at 614.937.2821to make sure your application has been received and so she can answer any questions you may have. The best time to call her is in the evenings 7:00pm-9:00pm or anytime on the weekends. You may also send an email to Beverly at whwt_rescue@yahoo.com Page 5 of 5 |
