West Highland White Terrier Society of CT Rescue
http://www.westiesocietyofct.com/rescue.html
FAMILY PROFILE and
APPLICATION FOR ADOPTION
or FOSTER CARE
Date _______________________________________
Full Name(s) _____________________________________________________________
Complete Address (no P.O. Boxes) ____________________________________________
________________________________________________________________________
________________________________________________________________________
Home Phone ______________________________ Work Phone _____________________
E-mail address ____________________________________________________________
Name & Relationship of others in the household (if minors, provide ages): (Continue
on back)
Name ______________________________ Relationship ___________________________
Name ______________________________ Relationship ___________________________
Name ______________________________ Relationship ___________________________
If there are children who regularly visit, please provide ages ________________________
Have you ever owned a dog? Yes _____ No _____
Do you still own a dog(s)? Yes _____ No _____
If Yes, is it neutered/spayed? Yes _____ No _____ If not, why?____________________
_____________________________________________________________________
Where is the dog(s) housed? (Inside / Outside / Both) Please describe: ________________
______________________________________________________________________
What happened to dogs no longer in your care? _________________________________
_____________________________________________________________________
List all pets currently in your home (Use back of page for additional pets)
Pet's Name: _____________________ Breed: ______________ Sex: ____ Age: ____ How
long?_______
Pet's Name: _____________________ Breed: ______________ Sex: ____ Age: ____ How
long?_______
Pet's Name: _____________________ Breed: ______________ Sex: ____ Age: ____ How
long?_______
Are all your pets current on their vaccinations? Yes _____ No _____
Name, Address, & Phone number of your Veterinarian: _____________________________
_______________________________________________________________________
_______________________________________________________________________
How long have you used this vet? _____________________________________________
(If you have no vet at this time, please contact one and provide the information
above)
Do you: Own _____ Rent _____ / House _____ Apartment _____ Condo _____ Other
_______
(If renting, we will need to see the rental agreement authorizing pets.)
Do you have a fenced yard? ________ If yes, what type of fencing? _________________
Do you have a pool or outdoor hot tub? ________
If yes to the above, is it fenced separately? _______
Does your job require frequent out-of-town travel? Yes _____ No _____
If yes, who will care for the Westie when you are out of town?
_____________________________________________________________________
Is your job subject to relocations? Yes _____ No _____
Does anyone in your household have animal allergies? Yes _____ No _____
If yes to abve, please explain: _______________________________________________
How did you hear about WHWTSOC Westie Rescue? ___________________________
_____________________________________________________________________
How did you decide upon a Westie? _________________________________________
_____________________________________________________________________
Desired Westie:
Age preferred: _______ - or - No preference _______ (We seldom have dogs under 3
years old)
If "no preference," would you be willing to adopt a Westie 8 years or older? Yes
___ No ___
Would you consider a pair of Westies if they became available? Yes _____ No _____
Sex preferred: Male _____ Female _____ No preference _____
Are you willing to house train? Yes _____ No _____
Are you willing to obedience train? Yes _____ No _____ If yes, where? _________________
Are you willing to adopt a Westie which may have slight health problems? Yes _____ No
_____
If not sure, are you willing to discuss as Westies become available? Yes _____ No _____
Who will be the primary care giver of the adopted Westie? ___________________________
How long will the Westie be alone each day? ______________________________________
How long will the Westie be alone in the evening? __________________________________
How will the Westie be housed when left alone? ___________________________________
Where will the Westie sleep at night?____________________________________________
Have you considered the length of commitment (Westies can live 15+ years) Yes __ No ___
Have you considered the annual expenses of vaccinations, food, and grooming?Yes __ No ___
List the two references not related to you and how long you have known them:
Name: ________________________________________Telephone_________________
Address: _______________________________________________________________
______________________________________________________________________
Relationship (neighbor, co-worker, etc.) __________________________How long? _____
Name: ________________________________________Telephone_________________
Address: _______________________________________________________________
______________________________________________________________________
Relationship (neighbor, co-worker, etc.) __________________________How long? _____
Do you understand that this Westie will be spayed or neutered
(either by this organization or you, depending upon the circumstances and age)? __________
Do you understand that no form of registration (such as AKC papers) will be given? ______
Do you understand that it will be your responsibility to provide medical care, proper
nutrition,
shelter, and training for this Westie as long as it is in your care? ____________
If fostering this Westie, how long will you be willing to do so?
______________________________________________________________
Do you understand that at no time will you be able to place this dog with anyone else with
out written permission from a representative of WHWTSOC Westie Rescue? ___________
I, the undersigned, certify that I have read the above information carefully and have filled out this application honestly. I understand omission of information and/or failure to answer all questions and sign the application can result in this application being denied. Also, if an omission or untruth is discovered after an adoption takes place, I understand that WHWTSOC Westie Rescue reserves the right to annul the adoption and reclaim the Westie. Should such a situation lead to legal process, I agree I am solely responsible for all costs, including attorney fees and court costs.
I understand that prior to being approved for adoption or foster care in my home, all of the above information will be verified, and by signing this, I give my permission for this verification.
I agree to a home and yard visit if it is required and also to a personal interview with a member of this rescue effort or their agent to determine the suitability of my home/facility to care for a Westie.
I further agree that if at any time, in the opinion of WHWTSOC Westie Rescue (or an agent), that it is to the benefit of the Westie's well being to be removed from my care, I will relinquish said Westie immediately and without negative incident. Should such a situation lead to legal process, I agree I am solely responsible for all costs, including attorney fees and court costs.
I understand and agree to make a minimum donation of Two Hundred Fifty ($250.00) which
goes directly toward helping to offset medical costs associated with Westie Rescue
services.
Adoption Candidate Signature _____________________________ Date ______________
Co-Adoption Candidate Signature __________________________ Date ______________
or
Foster Home Candidate Signature __________________________ Date ______________