West Highland White Terrier Club of Greater Atlanta, Inc. P.O. Box 844 Roswell, GA 30077-0844 Adoption Application

Primary Caregiver's Name (must be at least 21 yrs):

Co-Applicant's Name:

Address (no p.o. boxes):

City, State, Zip:

Home Phone: Work Phone:

Fax Number:   Email Address:

Please help us find the best Westie for you by answering the following questions:

Yes	No
		Are all children residing in the home age 7 or older? Important: Rescued Westies will not be placed in homes with children under the age of 7.
		Do children under the age of 7 visit regularly?
		Do you own a dog(s)? If yes, please describe breed, age and sex:
		Are all of your dogs spayed or neutered?
		Have you owned dogs that are no longer with you? If yes, please describe what happened to them:
		Do you own a cat(s) or other pet(s)? If yes, please describe:
		Are your pets housed inside?
		Do your pets visit a Veterinarian at least annually?
		Are all of your pets current on their vaccinations?
		Have you ever sold or given away a pet or surrendered one to a shelter?
		Do you own your own home or condominium?
		Do you rent a condominium or apartment? Important: If renting, please attach a copy of your rental agreement authorizing pets or a notarized statement from your landlord authorizing you to keep a dog on the premises.
		Do you have a fenced yard? If yes, what type of fence?

Yes	No
		Do you have a pool? If yes, does fencing enclose the pool?
		Do you have a hot tub? If yes, does fencing enclose the hot tub?
		Is anyone in your home allergic to dogs?
		Does anyone in your home have asthma?
		Are you willing to housebreak a Westie?
		Are you willing to obedience train a Westie?
		Will the Westie be alone during the day? If yes, how long?
		Will the Westie be alone in the evening? If yes, how long?
		Will the Westie be crated when alone for short absences? If no, please explain:
		Will the Westie sleep inside at night? If so, where?
		Are you aware that Westies can live 15+ years?
		Have you considered the added expense for vaccinations, food and grooming?
		Do you understand that the Westie will be spayed or neutered and will either be microchipped or required to be microchipped?
		Do you understand that no form of registration will be given, such as AKC papers?
		Does your job require frequent out of town travel?

How will the Westie be cared for during long absences?

Veterinarian's Name:

Address:

City, State, Zip:

Telephone Number:

How long have you used this Vet?

Why did you chose to adopt a Westie?

How did you hear about our rescue program?

Desired Westie:     Male Only   Female Only   No Gender Preference

Age preferred (Westies under three years old are very 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 problem?     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

References: Please list two people (not related to you) & how long you have known them:

Name:

Relationship:

Address:

City, State, Zip:

Telephone Number:

How Long?

Name:

Relationship:

Address:

City, State, Zip:

Telephone Number:

How Long?

I certify that I have read the above information carefully and have filled out this application honestly.
I understand omission of any information and/or failure to answer all questions and sign the
application 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 West Highland White Terrier Club of Greater Atlanta, Inc. (the “WHWTCGA”)
will visit my home for this purpose. By signing this application, I give my permission for this
verification and home visit. I further understand that if an omission or untruth is discovered before the
adoption, the application for adoption will be denied.

I understand that if an omission or untruth is discovered after the adoption of a Westie has taken place,
the WHWTCGA 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 WHWTCGA or their agent that represents
their rescue function 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 to the WHWTCGA (presently $275), to assist the club,
as the WHWTCGA incurs expenses for the care of Westies that have been rescued by our organization.
I acknowledge that the donation is not the sale of the Westie, and that if the Westie is returned for any
reason whatsoever, no portion of the donation will be refunded.

If you complete an adoption of a dog through our program, you will be offered a complementary
membership to the club for the remainder of the calendar year, unless the adoption occurs in the fourth
quarter, then your complementary membership would be through the following calendar year. Your
membership information would be completed at the time of the adoption contract completion.

Primary Caregiver Name (please print):

Signature:   Date:

Co-Applicant Name (please print):

Signature:   Date:

Please send the signed and completed application to: WHWTCGA Rescue, Post Office Box 844 Roswell,
GA 30077-0844. Note: If you live outside our adoption boundaries, your completed application will be
forwarded to the Westie Rescue Organization nearest to your address. Once we receive your application,
a member of our organization will contact you. Please be patient as our volunteers have full time jobs and
commitments.

There are times when we may not have dogs in the program, but we try to stay in touch to keep you
advised of the status of dogs coming into the program. If you acquire a dog and are no longer interested
in pursuing a westie through the rescue program, please notify us via our club Email
info@atlantawesties.org.