AIREDALE TERRIER CLUB

OF

METROPOLITAN WASHINGTON, DC, INC.

AIREDALE RESCUE & ADOPTION

Application for adoption

Name___________________________________Phone_______________Time to call__________

Address_________________________________________________________________________

How long at this address?_________If less that one year, please give

Previous address___________________________________________________________________

Home____Apartment____Condo____Other____Own____Rent____Urban____Suburban__Rural___

Occupation________________________________________________________________________

Please list all family members (including live-in help) and their approximate ages.

(You may want to take into account frequent visitors)_____________________________

Who will be assuming the main responsibility for this dog?_________________________________

Does everyone listed want an Airedale?____Male____Female____Age limit____________________

Do you have a fenced yard?____Type____Height____Approximate area________________________

Does your back door open directly into the fenced yard____or is the fenced yard

Detached from the house so that you must walk out to it?_______________________

PREVIOUS EXPERIENCE

Have you ever owned an Airedale?____M____F____

If not, why did you decide on an Airedale_________________________________________________

What other breeds have you owned?_____________________________________________________

Please list all pets you now have (include ages, sex, and whether animals are spayed/neutered_______

___________________________________________________________________________________
What happened to your last dog?________________________________________________________

How long ago?______________________________________________________________________

Have you ever lost a dog other than through death?_________________________________________

If so, how?_________________________________________________________________________

Have you ever given up a dog?____if yes, who?___________________________________________
If you had to move, would you consider giving up your dog?_________________________________
For what reasons would you give up your dog?_____________________________________________
Has your ownership of a dog ever caused you to be in an court situation?____If yes, please explain____
___________________________________________________________________________________

Are you ready for a dog now?___________________________________________________________

LIVING WITH YOUR DOG

Will your dog

Have “run of the house”:____________________________________________________________

If not, to what areas will he be restricted?_______________________________________________
Be allowed on the furniture?_________________________________________________________
Have his own chair?________________________________________________________________
Have his own dog bed/cushions here and there?__________________________________________

Sleep in your bedroom______________________________________________________________

If not, where?_____________________________________________________________________

How many hours a day is no one home?___________________________________________________
Where will he be during this time?_______________________________________________________

Are you familiar with a dog crate?_______________________________________________________
When would you use one?_____________________________________________________________

In what room would you put the crate?___________________________________________________
When you travel, where will your dog stay?________________________________________________
___________________________________________________________________________________

REFERENCES

Your Veterinarian__________________________________Phone______________________

Address_____________________________________________________________

PERSONAL REFERENCES: Please provide two, perhaps a friend and a neighbor

Name______________________________________________________________________

Address______________________________________________________________________
Name______________________________________________________________________
Address______________________________________________________________________

COMMENTS OR SPECIAL STORIES:________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Thank you for your application. If you are selected to receive one of our rescued Airedales, you will

Be contacted and further instructions given, regarding house checks, etc. Follow-up phone calls and

House visits are routine, to assure us that all is well

Date___________________________________________
Referred by_____________________________________________________________

Please return the completed application to:

Pam McKusick
5056 Ten Mills Road
Columbia, MD 21044
Phone: 410 730-3144
Email: mckusick@verizon.net

There is an adoption fee

We do reserve the right to refuse an application