Adoption Form

Westie Club Of The South

Westie Club of the South, Inc.
Atlanta Westie Rescue Committee (AWRC)
Application to Adopt a Rescued Westie

Primary Caregiver’s Name (Must be at least 21 years of age)
Co-Applicant’s Name
Street Address (no p.o. boxes)
City
State
Zip
Home Phone
Work Phone
Fax #
Email Address

Please answer all of the following questions and provide additional information as necessary.

If there are children in the home, are all children residing in the home age 7 or older? Yes No NA
Important: Rescued Westies will not be placed in homes with children 7 or younger.

Do children 7 or younger visit regularly? Yes No
Important: Rescued westies will not be placed in homes where children 7 or younger regularly visit.

Do you own a dog (s)? If yes, please describe breed, age and sex:

Are all of the dogs spayed or neutered? Yes No
If no, please explain:

Have you owned dogs that are still living but no longer reside with you? Yes No
If yes, please describe what happened to them:

Do you own a cat(s) or other pet(s)? Yes No
If yes, please describe:

Are your pets housed inside? Yes No
If no, Please explain:

Do your pets visit a Veterinarian at least annually? Yes No

Are all of your pets current on their vaccinations? Yes No

Have you ever sold or given away a pet or surrendered one to a shelter? Yes No
If yes, please explain:

Do you own your own home or condominium? Yes No

Do you rent a home, condominium or apartment? Yes No

Important: If renting, please submit a copy of your rental agreement authorizing pets or a notarized statement from your landlord
authorizing you to keep a dog on the premises. This must be submitted along with the application for it to be considered.

Do you have a fenced yard? Yes No
If yes, what type of fence

Do you have a pool? Yes No

Does fencing enclose the pool? Yes No

Do you have a hot tub? Yes No

Does fencing enclose the hot tub? Yes No

Is anyone in your home allergic to dogs? Yes No

Does anyone in your home have asthma? Yes No

Are you willing to housebreak a Westie? Yes No

Are you willing to obedience train a Westie? Yes No

Will the Westie be alone during the day? Yes No
If yes, how long?

Will the Westie be alone in the evening? Yes No
If yes, how long?

Rescued westies must be kept inside in a safe area when home alone.
Where will the Westie be kept during short absences?

Rescued westies must have an indoor place to sleep at night.
Where will the Westie sleep at night?

Are you aware that Westies can live 15+ years? Yes No

Have you considered the added expense for vaccinations, food and grooming? Yes No

Do you understand that the Westie will be spayed or neutered? Yes No

Do you understand that no form of registration will be given, such as AKC papers? Yes No

Does your job require frequent out of town travel? Yes No
If yes, what arrangements will be made for the Westie in your absence:

How will the Westie be cared for during long absences such as a vacation?

Veterinarian’s Name:
Address:
City, State, Zip:
Telephone #:
How long have you used this Vet?

Why did you choose to adopt a Westie?

Desired Westie: Male only Female only No gender preference
If you specified a gender preference, please explain:

Age preferred: (Puppies are seldom available.):

Would you be willing to adopt a Westie 8 years old or older? Yes No Not Sure

Would you be willing to adopt a Westie with slight health problems? Yes No Not Sure

Occasionally, a family will surrender more than one Westie. When possible, we try to place the Westies together. Would you be willing to adopt more than one Westie? Yes No Not Sure

Generally speaking, when are you available for a home visit? Home visits are a required part of the application process.
Weekdays Weekday evenings Saturday Sunday

References: (Required. References must be unrelated to applicant.)
Name:
Relationship:
Address:
City, State, Zip:
Telephone #:
How long?

Name:
Relationship:
Address:
City, State, Zip:
Telephone #:
How long?

How did you hear about the Atlanta Westie Rescue Committee?

I certify that I have read the above information carefully and have filled out the application honestly.
I understand omission of any information and/or failure to answer all questions could result in this application being denied.

I understand that prior to being approved for adoption all of the above information will be verified,
and a representative of the AWRC will visit my home for this purpose. I give my permission for this verification and home visit.
I further understand that if an omission or untruth is discovered, the application for adoption may be denied.

I understand that if an omission or untruth is discovered after an adoption of a Westie has taken place
the AWRC reserves the right to annul the adoption and reclaim the Westie. If this occurs, I agree to
relinquish said Westie immediately and without negative incident.

I further agree that if, at any time, it is the opinion of the AWRC or an agent that it is to the benefit
of the Westie to be removed from my care, I will relinquish said Westie immediately and without negative incident.

Should any such situation lead to legal process, I agree that I am solely responsible for all costs, including attorney fees and court costs.

I understand and agree to make a donation as assessed by the Westie Club of the South, Inc. personnel (typically $275)
which is applied to the expenses incurred in the care of Rescued Westies by the AWRC. I acknowledge that the donation
is not for the sale of the Westie, and that if the Westie is returned for any reason whatsoever, no portion of the donation will be refunded.

By checking this box, you agree to the terms and conditions stated above.

Optional donation to the general fund of the Atlanta Westie Rescue Committee (AWRC):

This optional donation would be used for the care of all of the AWRC rescued westies and is separate from the adoption donation described above.
Please make your check payable to the:

Westie Club of the South, Inc.
P.O. Box 669631
Marietta, GA 30066
Attn.: Kim Gage

Thank you for your support.