Biewer Terrier Rescue Adoption form

Adoption Application
 
Name:
Home Phone:
Address:
Cell Phone: 
City:
State:
Zip:
E-mail Address:
Best time and place to reach you: 
Occupation:
Employer:  
How long at current job:
Spouse/Significant Other's Name:
Occupation:
Employer:
How long at current job:
Personal References (not related to you please):
1) Name, Address, And Phone No# 
Relationship to applicant:
years Acquainted:

2) Name, Address, And Phone No# 
Relationship to applicant:
Years Acquainted:

3) Name, Address, And Phone No#
Relationship to applicant:
Years Acquainted:

Your Home
1.  Do you live in: [ ] House   [ ] Apt/condo/townhouse   [ ] Trailer   [ ] Other _ _
2.  Do you: [ ] Own [ ] Rent. If you rent, please provide the name, address, and phone number of the Landlord:_ _ 
3.  How long at your current address? _ _ years  _ _ months.
4.  Are you planning on moving within the next year? [ ] Yes  [ ] No.  If yes, please explain:
5.  Do you have a fenced yard? [ ] Yes   [ ]  No.   
Please provide specific measurements:
Do you have a kennel run: [ ] Yes   [ ] No.   
Please provide specific measurements:
If no to both of above, how will exercise/toilet be handled?
6.  What are the requirements of dog ownership in your community?  (i.e., licensing, rabies, leash laws, etc.):
7.  How many adults in your home?
Names and ages:
8.  How many children in your home?
Ages:
9.  Is there anyone in your home with animal related allergies? [ ] Yes  [ ] No.   
If  so, please explain:
10. Is there anyone in your home with a disability or special needs that we should be made aware of their  condition?

Other Pets
11.  Do you own any other dogs? [ ] Yes   [ ] No.   
Are they all spayed or neutered? [ ] Yes [ ] No.
12.  Any other pets/livestock? [ ] Yes [ ] No.
13.  List names, breed and sex of each of your current pets (cats, dogs, etc.):  
Pet #1:
Pet #2:
Pet #3:
14. How many dogs have you owned in the last 5 years?:
15. What happened to your last dog? [ ] Lost  [ ] Stolen  [ ] Given away  [ ]  Died  [ ] Other:
Please explain circumstances:
16.  Are all of your animals (dogs/cats) on heartworm preventative?  [ ] Yes   [ ] No.

Biewer Terriers
17. Have you owned a Biewer before? [ ] Yes  [ ] No.   
If no, how have you educated yourself about the breed?:
18. Why do you want a Biewer?: 
Why do you feel a Biewer is the right breed for you?:
19. What kind of dog do you want?:
Do you want: [ ] Male [ ] Female [ ] Doesn't matter.
Would you consider adopting a dog with a treatable health condition, i.e, heartworm? [ ] Yes [ ] No.
Would you consider adopting a dog with a disability?For example, deaf, missing limb, heart condition, etc. ?
[ ] Yes [ ] No.
Would you consider adopting a Biewer mix? [ ] Yes [ ] No.
Do you want: [ ] Under 1 year [ ] 1-5 years [ ] Over 5 years [ ] Doesn't matter.
What are your plans for this dog? [  ] Pet [ ] Guard [ ] Hunting [ ] Obedience [ ] Other.
20.  How far will you travel to adopt a dog?:

Living Environment   
21. Where will dog spend most of each day?  [ ] Indoors [ ] Outdoors.
If indoors: [ ] crate [ ] Basement/Garage [ ] free run of house [ ] limited area of house 
[ ] Other. (please explain):
If outdoors: [ ] Fenced yard [ ] Tethered [ ] Kennel [ ] Outside shelter [ ] Other:
Please provide specifics:
22.  Is someone home at all times or will the dog need to be alone for a portion of the day? 
How many hours will dog be alone each day?:
23. Where will dog sleep?  [ ] Indoors or [ ] outdoors.
If indoors, where?  [ ] Crate [ ] Dog Bed [ ] Family Member’s Bed [ ] Basement/Garage. 
If outdoors, where?:  [ ] Fenced yard [ ] Kennel [ ] Other.  Please provide specifics:

Exercise and Discipline
24. How would you exercise the dog? [ ] Fenced area attached to home  [ ] Walks on leash. 
Other - please explain:
25. Have you ever obedience trained a dog before? [ ] Yes [ ] No.
Are you willing to attend obedience classes with your dog? [  ] Yes [ ] No.
26.  What is your definition of disciplining a dog?:
27. How would you handle a dog’s destructive behavior?  For example, dog gets into garbage, etc.:

Food and Other Expenses
28. What brand of dog food would you use & what will be your Biewer's eating schedule?: 
29. What would you consider a realistic cost to properly care for a dog for one year? Please explain:
30. What other expenses would you expect to pay? Please explain:
31. Name, Address, and Phone No# of Your Veterinarian:

Miscellaneous
32. What would you do if you could not keep the dog?
33.What circumstances, in your mind, justify getting rid of a dog?
34. Are you currently working with any other rescue?  [ ] Yes [ ] No.
If yes, please provide the name, phone number, and e-mail address so that we may collaborate our efforts:
35. Do you agree to the following?
Spay/Neuter within 30 days, if applicable? [ ] Yes [ ] No. 
Return dog to Biewer Terrier Rescue if you can no longer keep or care for dog? [ ] Yes [ ] No:
Allow Biewer Terrier Rescue agent to visit your home prior to adoption? [ ] Yes [ ] No.
36. Further comments or additional information that you feel might help us find the right Biewer for your home:
Date:_/__/_

Please provide us with any other information you feel would be helpful in assisting us in consideration of your application:

Thank you!