Thank you for your interest in Maryland Westie Rescue. Please answer the following questions so that we may evaluate and select the correct dog for you. All information is confidential. Please note that at any time during the application process we determine that any of your responses are misleading or less than truthful, your application will not be considered further. Also, please take care to ensure that the application is completed in full before you hit the submit button inasmuch as incomplete applications will be ignored.

Generally, adoption costs are:

• Up to one (1) year old - $400.00
• Over one (1) but under two (2) years old - $350.00
• Over two (2) but under four (4) years old - $300.00
• Over four (4) but under eight (8) years old - $250.00
• Over eight (8) years old - $150.00 (may be adjusted down based on age)

MWR reserves the right to modify the above amounts at any time without notice. Adoption costs may be lowered depending on any known health conditions of any particular Westie.

Our dogs are fully vetted before they are placed into adoptive homes (there are some exceptions due to health and/or age). They will be neutered/spayed, brought up to date on their vaccinations, tested for heartworms, and may have a dental cleaning. And in most cases, our costs exceed the adoption donation amount we get for the dog.

Applicant Information: Name of Applicant: Name of Spouse or Co-applicant: Relationship of Co-Applicant to Applicant: Address: City: State: Zipcode: Home Phone: Work Phone (optional): Cell Phone (optional): Applicant's E-mail: Co-applicant's E-mail: Applicant's Age: Co-applicant's Age: Applicant's Employer: Co-applicant's Employer: Does your job require frequent out-of-town travel? Yes No If yes, who will care for the dog when you travel?: Is your job subject to relocations? Yes No Household Data: Single Married Sharing Home with Unrelated Adults Number of Children in Household (include sex and age) or grandchildren (or other children) that regularly visit. Do you own or rent?: Own Rent Residence Type: House Townhouse Condo Apartment Other Do you have a securely fenced yard? If yes, what type of fencing? Do you have a pool or outdoor hot tub? If yes, is it fenced separately? Tell us about your pets: Have you ever owned a dog? Yes No If yes, what breeds? Do you still own a dog(s)? Yes No If yes, it he/she spayed/neutered? Yes No If any of your current pets are not spayed/neutered, please explain why: Where is the present dog(s) housed? (Inside, outside, both) Please describe: What happened to dogs no longer in your care? List all pets currently in your home. Include Breed, Sex, Age, and how long you've had the pet: Pet 1: Pet 2: Pet 3: Pet 4: Pet 5: Pet 6: Are all of your pets current on their vaccinations? Yes No Name, Address and Phone Number of your Veterinarian (or the one you plan to use): How long have you used this Veterinarian? Desired Westie: Gender of desired Westie Male Female No preference Preferred Age of Westie: Puppy Under 3 years old Under 5 years old Under 8 years old No age preference If no age preference, would you be willing to consider a Westie age 8 years old or older? Yes No Would you consider a pair of Westies if they became available? Yes No Would you consider a Westie-Mix? Yes No Are you willing to housetrain? Yes No Are you willing to consider a Westie with slight health problems? Yes No Not sure, but willing to discuss Who will be the primary care giver of the adopted Westie? How long will the Westie be alone each day? How long will the Westie be alone each evening? Where/how will the Westie be housed when left alone? Where will the Westie sleep at night? Will the Westie be allowed on the furniture? Yes No Have you considered the length of commitment (Westies can live 15+ years)? Yes No Have you considered the annual expenses of vaccination, food, grooming, etc.? Yes No References: List two personal references not related to you and how long you have known them: Reference 1 Name and Address: Telephone Number(s)? How long have you known this reference? Reference 2 Name and Address: Telephone Number(s)? How long have you known this reference? Additional comments or information you would like to share with us: Considerations to note: Applicant understands that the rescue dog will be spayed or neutered (either by Maryland Westie Rescue or the applicant, depending upon the circumstances and age of the dog. Applicant understands that no form of registration (such as AKC papers) will come with the dog. Applicant understands that it will be the applicant's responsibility to provide medical care, proper nutrition, shelter, and training for the rescue dog as long as it is in your care. Applicant understands that at no time will applicant be able to rehome the rescue dog with anyone else without written permission from an authorized representative of Maryland Westie Rescue. By submitting this electronic application, I certify that I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and/or sign the application can result in this application being denied. Also, if an omission or untruth is discovered after an adoption takes place, I understand that Maryland Westie Rescue reserves the right to annul the adoption and reclaim the dog. Should such a situation lead to legal process, I agree I am solely responsible for all costs, including attorney fees and court costs. I understand that prior to being approved for adoption or foster care in my home, all of the above information will be verified, and by signing this, I give my permission for this verification. I agree to a home and yard visit if it is required and also to a personal interview with a member of this rescue effort or their agent to determine the suitability of my home/facility to care for a dog. I further agree that if at any time, in the opinion of Maryland Westie Rescue (or an agent), that it is to the benefit of the dog's well being to be removed from my care, I will relinquish said dog immediately and without negative indicent. Should such a situation lead to legal process, I agree I am solely responsible for all costs, including attorney fees and court costs. Depending on the dog which I am adopting, I understand that the adoption costs may range from $150 to $400 and will go directly toward helping to offset medical costs associated with Maryland Westie Rescue's services.