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APPLICATION FOR ADOPTION |
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- Please print this application and mail to the San Francisco, CA address given on the last page.
| PERSONAL
INFORMATION
Name of Applicant___________________________________________________________________________________ Home Address:_____________________________________________________________________________________ City/State/Zip:______________________________________________________________________________________ Home Phone:______________________Work Phone:_______________________Cell Phone: _____________________ Best Time and Best Number to Reach You:_______________________________________________________________ E-mail address:_____________________________________________________________________________________ Do you own a second home where you will be taking your dog? If yes, add the address here and describe how often you visit this home: Your 2nd Home Address: ______________________________________________________________________________ Your City/State/Zip: ___________________________________________________________________________________ How often do you visit this home: ________________________________________________________________________ Your Employer:_____________________________________________________________________________________ Your Days and Hours at work:_________________________________________________________________________ Name of Co-Applicant: ________________________________________________________________________________ Relationship to Applicant:_____________________________________________________________________________ Co-Applicant's Employer:_____________________________________________________________________________ Co-Applicant's Days and Hours at work: _________________________________________________________________ Co-Applicant's E-mail address: _________________________________________________________________________ Your Age: ____________________________________ Co-Applicant's Age: _____________________________________ Household Data (Circle) : Single Married Sharing Home with Unrelated Adults Number of Adults in Household: _____________________ Men____________________ Women____________________ Do all the adults in your household approve of getting a dog? (Circle) Yes No Have you ever RESCUED a dog or cat or other pet before? (Circle) Yes No If yes, what breed or pet did you rescue and from what organization or animal shelter: _____________________________ ____________________________________________________________________________________________________ Number of children in household (include sex and age of each child): __________________________________________________________________________________________________ __________________________________________________________________________________________________ If grandchildren visit or you visit them with your pets, please list the age and sex of each grandchild: __________________________________________________________________________________________________ __________________________________________________________________________________________________ Does anyone in your household have allergies to dogs or asthma?____________________________________________ How many other dogs and other pets (including turtles, chickens, cats, chinchillas and other rodents) in your household? (List species, breed, sex, age, spayed or neutered) __________________________________________________________________________________________________ __________________________________________________________________________________________________ If you presently have any other dogs, are they current on vaccinations (rabies, distemper, hepatitis, parvovirus and parainfluenza at minimum) and on heartworm and flea preventative? ___________________________________________________________________________________________________ Veterinarian's Name:___________________________________________Phone:_________________________________ E-mail:_____________________________________________________________________________________________ Address:___________________________________________________________________________________________ __________________________________________________________________________________________________ What breeds of dogs have you previously owned and for how long? __________________________________________________________________________________________________ __________________________________________________________________________________________________ If you ever had a dog die at less than 10 years of age, become lost or disappear, please provide details: __________________________________________________________________________________________________ __________________________________________________________________________________________________ If you have ever sold or given away a pet to anyone or surrendered a pet to a shelter, please provide details: __________________________________________________________________________________________________ __________________________________________________________________________________________________ Are you a member of the following organizations: ASPCA, HSUS, dog club, kennel club, breed club, rescue organization? If yes, please list: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Have you or anyone in your household ever been convicted of cruelty to animals? _________________________________ Are you under suspension from any pure bred dog association such as The American Kennel Club? If yes, please explain: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ HOME INFORMATION Circle your type of dwelling: House Apartment Condo Duplex/Triplex Townhouse Farm Mobile Home Other ___________________________________________________________________ Do you rent or own your dwelling? ______________________________________________________________________ If you rent your home, does your lease allow for a dog under 25 pounds?_______________________________________ Your Landlord's Name:_____________________________________________Phone_____________________________ (If you rent, please provide a copy of lease or notarized statement from landlord authorizing pet occupancy with your adoption application.) Do you have a securely fenced yard?_____________Approximate size:________________________________________ Type of fence:___________________________________________________________Height:______________________ Have you inspected the fence for holes that a Westie could crawl or dig through?________________________________ Are the gate latches secure?______________________Can children open the gates?____________________________ Do you have a swimming pool or spa?______________Is it fenced separately or tightly covered?_____________________ Type of fence:____________________________________________________________Height______________________ Width of space (inches) between slats of fence and/or between deck railings and clearance underneath: ___________________________________________________________________________________________________ If the yard and pool area are not securely fenced, what type of improvements can be made so that it is secure? __________________________________________________________________________________________________ __________________________________________________________________________________________________ Are you willing to make these improvements?_____________________________________________________________ Are you aware of distractions or dangers that might annoy or harm your dog inside your yard (i.e., loose dogs, mischievous children, wildlife including coyotes, skunks, raccoons)? __________________________________________________________________________________________________ Can anyone gain access to your yard from the street?______________________________________________________ If your yard is not fenced, how do you plan to insure the dog receives safe and adequate exercise? __________________________________________________________________________________________________ __________________________________________________________________________________________________ Will you allow a member of the SFBWHWTC Rescue Committee to visit your home?_____________________________ WESTIE INFORMATION Are you familiar with the temperament of a Westie?________________________________________________________ Have you owned a Westie before?____________If yes, when?________________________________________________ How long did you have each Westie?____________________________________________________________________ Where did you obtain your previous Westie(s)? ___________________________________________________________ __________________________________________________________________________________________________ Why are you interested in obtaining a West Highland White Terrier?___________________________________________ __________________________________________________________________________________________________ Who will be the primary caregiver for this Westie? _________________________________________________________ Is someone home during the day?______________________________________________________________________ How many hours a day will the dog be alone?_____________________________________________________________ Where will the Westie stay when no one is home? In a Crate__________________ In One Room __________________ In the Garage __________________ Loose in the House__________________________________ In the Yard_________________________________ Other: _____________________________________________________________________________________________ Do you plan to keep the dog primarily indoors or outdoors? __________________________________________________ Where will the Westie sleep at night?____________________________________________________________________ Do you plan to use a Crate? Why or why not? ____________________________________________________________ ___________________________________________________________________________________________________ What are your plans for exercising the Westie? ___________________________________________________________________________________________________ Have you considered the annual expenses for your Westie (i.e., veterinary care, food, grooming, licensing)? Please give an estimate of the annual costs. ___________________________________________________________________________________________________ Are you willing to commit to caring for this dog for its lifespan? (Westies can live 15+ years)_______________________ If you have to move, what would you do with the Westie? ___________________________________________________________________________________________________ Will you put a written plan in place (with your Will and other important papers) for the care of your dog(s) in the case you are no longer able to care for your dog(s)? ___________________________________________________________________________________________________ In case of emergency, who will take responsibility for this West Highland White Terrier? Name:_____________________________________________________Phone(s):________________________________ E-mail:______________________________________________________________________________________________ Address:___________________________________________________________________________________________ __________________________________________________________________________________________________ Does your job require out of town travel?________________If yes, who will care for your dog during your absence? __________________________________________________________________________________________________ Have you considered adopting two (2) Westies, i.e., siblings or long-term family members?_________________________ If such a circumstance were to occur, would you like us to contact you?_______________________________________ Gender of Westie you prefer: Male______________ Female_______________ No Preference_________________ Age range of Westie you prefer:________________________________________________________________________ Would you be interested in a young adult or a puppy? ______________________________________________________
Are you willing to adopt a Westie-mix?__________________________________________________________________ Are you willing to adopt a Westie with the following special needs? Please check/circle all applicable: (Click the links for more information about each condition)
Are you willing to housetrain a dog?_____________________________________________________________________ Are you willing to attend Obedience class with a dog?______________________________________________________ Describe how you discipline a dog: _____________________________________________________________________ __________________________________________________________________________________________________ Do you agree to return the Westie to the SFBWHWTC Rescue Committee should some circumstance arise where you would not be able to keep this dog? __________________________________________________________________________________________________ REFERENCES Please list three personal references (name, address, e-mail, phone, years known and how): 1._________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ 2._________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ 3._________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________
How did you hear about us?____________________________________________________________________________ Please use this area (or the back of this page) to add any information you feel would assist us in the placing of a West Highland White Terrier in your home. We would appreciate if you could give us some insight into the expectations you may have for this new family member. Also please describe what makes you a good pet owner. __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ |
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I agree to have my name added to the waiting list for the purpose of giving a Westie a loving and permanent home. I understand the SFBWHWTC Rescue Committee does not buy or sell any West Highland White Terrier dogs. The SFBWHWTC Rescue Committee exists for the purpose of finding, safe, loving homes for Westies that no longer have a home. I understand I will be contacted by a member of the SFBWHWTC Rescue Committee for potential placement. The San Francisco Bay West Highland White Terrier Club reserves the right to refuse adoption to any applicant. I understand the $10.00 processing fee is nonrefundable. It does not guarantee you will be adopting a Westie from the SFBWHWTC. If you get a dog from another source or change your mind about adopting a dog from the SFBWHWTC and want your name removed from our files for prospective adopters please call and inform us. Your signature(s) below signifies that you have read the contents of this application and have answered all questions truthfully. This application will serve as part of your adoption agreement and therefore should be viewed as legally binding. Any misrepresentation of facts on this application may result in your disqualification as an adoption candidate or repossession of your adopted dog.
Adoption Candidate's Signature:___________________________________________________Date:____________________
Co-Applicant's Signature:___________________________________________________Date:____________________
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