Canadian West Highland White Terrier Club Adoption Application

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1/9 Adoption Application 5283788 Manitoba Limited, o/a Canadian West Highland White Terrier Club &/or Le Club Canadien du terrier Blanc du West Highland Canadian West Highland White Terrier Club Adoption Application Applicant Name: Co-Applicant Name: Full Address (No PO Boxes): Mailing address (if different): Home Phone: Fax: Work or Cell phone: E-Mail Address: List all adults (family members and non-family members) who reside in the household (Name, age, occupation) List all children under the age of 18 who reside in the household by name, age and relationship to you: 2/9 Adoption Application 5283788 Manitoba Limited, o/a Canadian West Highland White Terrier Club &/or Le Club Canadien du terrier Blanc du West Highland List all non-resident children under the age of 18 who frequently visit your household by name, age, relationship to you and duration of visit: List all non-resident adults who frequently visit your household by name, age, relationship to you and typical duration of visit. This should include any employee who has regular access to your home and property: Activity Level 3 list hobbies/activities which you and your family actively participate in: Indicate the energy level that you would like a Rescue Westie to have: Laid Back Couch Potato ... more. less.

Energetic Somewhere in Between Does anyone in your household have allergies or asthma? Yes / No If yes, list the members and describe their reaction to animals: Who are you adopting the Westie for?: Myself My Spouse My Child The Whole Family Does everyone in the household agree to adopting a Rescue Westie?: Yes / No 3/9 Adoption Application 5283788 Manitoba Limited, o/a Canadian West Highland White Terrier Club &/or Le Club Canadien du terrier Blanc du West Highland Why do you want to adopt a Rescue Westie?: Why do you feel that a Westie would be the perfect pet for you and your family? Have you previously owned a dog or cat? Yes / No How many dogs have you owned in the past 10 years? Describe the pets that are no longer with you. List breed or type, age and why they are no longer with you. Please be specific: If you previously owned a Westie, please tell us about him/her: 4/9 Adoption Application 5283788 Manitoba Limited, o/a Canadian West Highland White Terrier Club &/or Le Club Canadien du terrier Blanc du West Highland What research have you done to learn about Westies? List all current pets in the household (breed/type, species, age, gender, fixed or not, current health and temperament) What type of home do you live in (single dwelling, townhouse, condo, apartment, other): If you live in a condo or apartment, it is on the ground floor or upper level? Does your building allow pets? If you rent, please provide the Landlord 9s name, address, phone number: Do you have a balcony? Yes / No Do you have a deck? Yes / No If Yes, please describe the type and height of railings: 5/9 Adoption Application 5283788 Manitoba Limited, o/a Canadian West Highland White Terrier Club &/or Le Club Canadien du terrier Blanc du West Highland How would you describe the area in which you live: Urban Suburban Semi-Rural Rural If you have a yard, is it fenced? Yes / No Is that fence secure? Yes / No Please describe the fence 3 materials and height, plus size of fenced yard. Do you have electronic/underground fencing? Yes / No If no, do you plan to install this type of fencing? Yes / No If you do not have a fence, please describe how you plan to keep your Westie from roaming off of your property: Do you understand and agree that a Westie should never be left off-leash outside, for even a moment, unless it is inside a security fenced area? Yes / No Where do you plan to keep a Westie during the day? Indoors: Loose Crated Basement Specific Room Outdoors: Loose Fenced Yard Tied up Kennel Run Garage Other: Who will be responsible for feeding/grooming/training? Are you willing to take a Westie to Obedience Classes if necessary? Yes / No Is anyone home during the day? Yes / No If so, how do they plan to interact with the Westie during the day? 6/9 Adoption Application 5283788 Manitoba Limited, o/a Canadian West Highland White Terrier Club &/or Le Club Canadien du terrier Blanc du West Highland How many hours a day will the Westie be left at home unattended? How many hours inside? How many hours outside? How frequently will the adults be away from home on business trips, vacations or other activities? When you are away on a trip, where will the Westie be kept? - At your home with someone coming over to feed ______ - Stay with a friend - Pet sitting service - Boarded at Kennel - Other What do you plan to feed the Westie? Would you consider adopting a Westie that is not yet housetrained? Yes / No If Yes, how do you plan to housetrain them? Your Westie Wish List: What gender do you prefer? Male Female No Preference If you selected a gender, would you consider the opposite gender? Yes / No What age would you prefer? Puppy Youngster (1-3) Teen (4 3 7) Mature (8-10) Senior (11 +) If you selected a younger dog, would you consider accepting a Mature or Senior if one was available and needed a new home? Yes / No Rescue dogs often come with problems, which could include skin or health issues and which would require medication or special care (baths, etc) or special diets. Would you consider a Special Needs Westie? Yes / No 7/9 Adoption Application 5283788 Manitoba Limited, o/a Canadian West Highland White Terrier Club &/or Le Club Canadien du terrier Blanc du West Highland Please list the issues that you feel you would be able to cope with: Do you agree to keep the Westie licensed and have identification with your name and phone number on the Westie at all times? Yes / No Do you agree to comply with ALL applicable City/Town/Count and Federal laws as they relate or pertain to the care, treatment and responsibility of dog ownership? Yes / No Do you agree to keep in contact with CWHWTC Rescue throughout the time you have possession of a Rescue Westie, to give updates on the Westie? Yes / No Do you agree to contact CWHWTC Rescue if you can no longer care for this Westie? Yes / No Are you willing to provide a crate for your Rescue Westie to help during the transition period as they adjust to your home and routine? Yes / No Do you agree to allow a rescue representative to visit your home by appointment to do a csafety d inspection? Yes / No Are you able and willing to make a Rescue Adoption Donation if you adopt a Westie through CWHWTC Rescue? Yes / No Signature Applicant Signature Co-Applicant Date: References : (3 required) Reference #1 Name: Address: Phone: Relationship: 8/9 Adoption Application 5283788 Manitoba Limited, o/a Canadian West Highland White Terrier Club &/or Le Club Canadien du terrier Blanc du West Highland Reference #2 Name: Address: Phone: Relationship: Reference #3 Name: Address: Phone: Relationship: Veterinarian Reference (Required for current or former pet owners) Name of Veterinarian: Name of Clinic: Address: Phone: Veterinarian Reference #2 (If you have recently changed Veterinarians) Name of Veterinarian: Name of Clinic: Address: Phone: 9/9 Adoption Application 5283788 Manitoba Limited, o/a Canadian West Highland White Terrier Club &/or Le Club Canadien du terrier Blanc du West Highland Please send the completed form to: By Canada Post: CWHWTC Rescue Brigitte Dimock P.O. Box 25074 Guelph, ON, N1G 4T4 By phone: 519-822-0308 By fax: Please call before faxing. By email: rescue@canadawestieclub.ca

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