Me and My Family

4/3/18 WAG N TRAIN TERRIER RESCUE - ADOPTION APPLICATION 1

You and Your Family

Please Note: You must be 21 years old to complete an application.

Applicant Name: E-mail Address:

Home Address: Home Phone:

City: State: Work Phone:

Zip: Best Time to call:

Employer of Applicant:

Co-Applicant Name: E-mail Address:

Address: (if different than above):

Employer of Co-Applicant:

Number of adults in home: Number of Children (include ages):

If no children, but you have children that visit, please list their ages: Dog Preferences Are you interested in a specific dog from our site? Name:

Preferences: 1. Gender 2. Age 3. Coat (smooth/wire/long) 4. Color

Are you willing to accept a dog with a history of neglect/abuse?

Are you willing to accept a dog with behavior problems (fear, potty training, digging, etc?)

Would you consider a terrier mix or other breed?

Is there a time-limit in your finding a new rescued family member? If, yes, please explain:

Why a Rescue Dog? Have you previously owned a Rescue Dog?

What do you like about the Terrier breed, or rescue dogs?

What breeds are you considering?

Describe what you feel are the characteristics of the ideal Rescued Dog for you & your family.

Are you prepared for the costs of veterinarian care, to include basics (shots, worming, annual heart worm checks, maintenance); as well as, the potential for non-routine/emergency veterinarian care, especially as your rescue dog ages? 4/3/18 WAG N TRAIN TERRIER RESCUE - ADOPTION APPLICATION 2

Your Home Please check which applies to your current residence.

Home Owner Home Renter Apartment Other

If you rent a home or apartment, do they allow pets?

Is your yard, or a portion of your yard, securely fenced? If YES what is the fence height? Of what material is the fence made?

If you have a pool, is it fenced?

If you have a dog run, is it secure?

Do you have a doggy door? If so, when are dogs allowed access?

If you live in an apartment or do not have a fenced yard, please describe how you plan to exercise your Rescue Dog and allow it to relieve itself:

Please list all current pets that you own or foster. Include breed, age, gender, and how long you have owned them, and if they live indoors/outside:

Are you within the animal number limits for your area if you add a new dog to your home?

What is the limit number for your city/county?

Care and Responsibility Approximately how many hours per day will your rescue dog be alone?

How long will your rescue dog be left outside?

Where will your rescue dog be, when left alone?

Where will your rescue dog sleep at night?

Who will have primary responsibility for the care of your rescue dog?

Do you travel frequently? If yes, who will take care of your adopted dog?

Have you asked yourself whether your lifestyle is so busy you might not have the time or energy to properly care for a rescue dog?

Are you willing to take your rescue dog, and restrict your choice of housing, to places where pets are allowed?

Does everyone in the family want a rescue dog?

Does anyone in the household have any known allergies to animals?

What is your definition of disciplining a dog?

What will you do if your spouse, children or pets can't get along with the rescue dog?

Have you applied to adopt, or have you adopted from a rescue before? 4/3/18 WAG N TRAIN TERRIER RESCUE - ADOPTION APPLICATION 3

HISTORY OF PET OWNERSHIP Please list below all pets previously owned (not listed above), when you last owned them, how long you owned them, what happened to them, and month/year sold, lost, died:

References Please provide three names as references; YOUR FIRST REFERENCE MUST BE YOUR VETERINARIAN. You must include your landlord (if you rent your home or apartment) as a 4th reference. Other references could include a neighbor or anyone who knows you, such as a friend, relative or co-worker who has knowledge of you with your dogs past or present. All 3 references may not be relatives. Your references will be checked! Your application will NOT be considered if you do not complete this section. 1. MUST BE YOUR VETERINARIAN (Please call your veterinarian, to ensure we are able to obtain information, when we call)

a. Clinic Name:

b. Animals listed with this Vet (alive/deceased):

c. Phone Number/best time to call:

2. Personal Reference Name:

a. Relationship:

b. Phone Number/best time to call:

3. Personal Reference Name:

a. Relationship:

b. Phone Number/best time to call:

4. LANDLORD (only if you rent)

a. Name:

b. Phone Number/best time to call

All of the information I have provided is true and complete to the best of my knowledge. Should a Rescue Dog be placed with me, it will reside in my home as a pet. I agree to provide my new dog with adequate food, water, shelter, affection and medical care.

I understand that my application does not constitute a guarantee or hold of any type on a specific dog offered for adoption with Wag N Train Terrier Rescue Signature of Applicant: Date of Application:

Signature of Co-Applicant: Date of Application: 4/3/18 WAG N TRAIN TERRIER RESCUE - ADOPTION APPLICATION 4

Filing Process:

Electronic filing: You may fill this application out on your computer. If you have a scanner, please sign the last page of the application, scan to your computer and email. If not, type your legal name in the Signature area (electronic signature), save your file and email to: [email protected]

Paper filing: Mail your competed application to: Wag N Train Terrier Rescue 1006 N. 77th Street Omaha, NE 68114

How long does the process take?

The answer depends on the availability of your references, and your location (for home inspection). If your application has been selected for processing, you will receive a response from one of our volunteers within 72 hours (Mon-Fri). Please be patient with our all-volunteer rescue.

Once references have been checked and if all are positive, we will then contact you to arrange for the home inspection. If you live outside our local area, we will make every attempt to find a rescue volunteer in your area to assist us.

The completed home visit report is then submitted to our Board of Directors for review. If approved, you will be notified within 72 hours and we will then arrange a date/time to complete the adoption. In most cities/towns, you have up to 30 days to register your terrier with your local animal control registry/authority.