Midwest Wheaten Rescue Adoption Application
Your full name
Spouse / Partner's name
Your email address
Your phone number and best time to reach you
Your physical address
Which dog are you applying to adopt? (please specify your first choice)
Please specify your second choice
If these choices are not available, what age Wheaten are you interested in?
Are you willing to adopt an older Wheaten (age 7+)?
Yes
No
Are you willing to adopt a Wheaten with special medical needs?
Yes
No
Are you willing to provide basic training, using reward rather than punishment, for your Wheaten?
Yes
No
Which gender Wheaten do you prefer?
Male
Female
Veterinarian's name and address (Your vet will be contacted for a reference. Please contact your vet and give them permission to answer our questions about the care of your pets)
Vet's phone
I hereby give permission to call my vet for a reference
Yes
No
How many adults reside in your home, and what are their ages?
How many children reside in your home, and what are their ages?
Who will be the primary person taking care of the Wheaten you want to adopt?
Do you live in a house, apartment, condo, town home? Do you own or lease/rent?
If you live in a house, is your yard enclosed by a fence? If yes, what type of fence?
If no, how will you handle exercise and toilet duties?
If an apartment / condo / town home, how will you handle exercise and toilet duties?
Do you currently have a dog?
Yes
No
If yes, please tell us how many dogs, their names, what breed they are, and what are their ages?
Are they spayed / neutered?
Besides dogs, do you have any other pets? If yes, what are they (cats, ferrets, rabbits, etc), what are their names and ages?
Have you owned any other pets in the last 10 years? If so, where are they now?
Does everyone in your family want this Wheaten?
Are you aware that Wheatens need grooming, ear, and nail care every 4-6 weeks? Are you willing to provide this for your Wheaten?
Do all adults in the household work outside the home?
Will the dog be home alone while you're at work? If so, how long will the dog be left alone for?
How and where will the dog be spending his/her time during the day?
How and where will the dog be spending his/her time at night? Where will he/she sleep?
Where will the dog stay when you leave town (vacations, etc)
Why do you want a rescued pet, and how are you prepared to meet their special requirements?
Additional comments - anything you'd like us to know (and we haven't already asked)
Initials and date. I am at least twenty-one (21) years old and ready to adopt and take possesion of a dog now.
Initials and date. I understand, that this Wheaten Terrier, MUST be an INDOORS pet. This dog will be an inside dog and will not be left unattended outside.
Initials and date. I will provide reasonable and necessary vet care to this Wheaten, including monthly Heartworm, Flea, Tick, and Intestinal parasite prevention.
Initials and date. If this adoption is for a young puppy, I agree to Spay/Neuter the pup at 6 months of age or as soon as my vet feels, that it is old enough.
Initials and date. I further understand, if for ANY reason, that this Wheaten does NOT work out, I will return it to Midwest Wheaten Rescue.
Initials and date. I also further understand, that this dog may not be given to, sold or placed with a third party including family members. If you, the adopter, do not keep this dog, it must be returned to Midwest Wheaten Rescue.
The adopter further agrees to accept all responsibility for any harm caused by the dog to humans, other animals or personal property following adoption, including, without limitation, any damages resulting from bites, scratches or any other form of aggression, and any damages resulting from the dog's failure to become housebroken.
Yes, I agree
No, I do not agree
Initials and Date
Indicates Response Required
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