Oklahoma Airedale Terrier Rescue Adoption Application

CONTACT INFORMATION

TODAY'S DATE:

Your Name ( required )
First Name:
Last Name:

Your Age: ( required )

Your Occupation:

Spouse/Partner (if any) Name:
First Name:
Last Name:

Spouse/Partner Age:

Spouse/Partner Occupation:

Your E-Mail Address (required)

Spouse/Partner E-Mail (optional)

Home Street Address (required)

Mailing Address (if different)

City ( required )

State

Zip Code

Home Phone #

Best Time to Call

Home Fax # (if any)

Your Work Phone # (if you can receive calls at work)

Best Time to Call (if you can receive calls at work)

Your Mobile Phone #

Spouse/Partner Work Phone # (if spouse/partner can receive calls at work)

Best Time to Call (if spouse/partner can receive calls at work)

Spouse/Partner Mobile Phone #

RESIDENTIAL INFORMATION

House Condo Apartment
Ranch or Farm Mobile Home
Other(describe)

Years in Residence Less than 1 1-2 years 2-4 years
5-9 years 10-20 years more than 20

Own Rent

If you rent, written permission for dog?
Yes No N/A

Landlord (Name, Address, Telephone)

If your yard is fenced, describe the type of fencing.
No Fenced Yard

Height of the fence at the lowest point accessible to the dog:
4-1/2 feet or less
5 feet
5-1/2 feet
6 feet or higher
No Fenced Yard

Is the fence is intact on all sides, without any gaps?
Yes No

Are there gates in the dog's yard?
Yes No

How many gates?

How high are the gates?

Is there any type of lock on the gate(s)?
Yes No

Type of lock (padlock, key, latch, etc.):
If no locks, would you be willing to install them prior to placement?
Yes No

Other than the family, who has access to the dog's yard (gardner, pool maintenance, meter readers, neighbors, etc.)?

Are there any gaps between the ground and the bottom of the fence or gates?
Yes No

Describe the outside dog area (earth, grass, gravel, cement slab, tarmac, etc.)

Does a door from the house open directly to the fenced yard?
Yes No N/A

Dog Door?
Yes No Willing to Install

If you have a dog door, what are the inside measurements (height and width)?

Do you have a swimming pool? Yes No

Can the dog get into the pool from the dog yard?
Yes No

If your new dog liked to swim, would you allow it in the pool?
Yes No

Does your town have a leash law?
There IS a leash law in my town
There IS NOT a leash law in my town
Don't know

FAMILY INFORMATION

Names and ages of all children who live or regularly stay in your home (i.e., grandchildren, nieces/nephews):

Names and ages of other occupants of home
(Humans only -- You will be asked about pets later in the form)

If children live or regularly stay in your home, describe their previous experience with dogs.

Are you or your children planning to have children in the next five years?
Yes No

What is your primary reason for wanting a dog?
Companion for you For your kids
Gift For other pet Watchdog
Other:

What is it about an Airedale that makes you want to own one?

Do all family members want an Airedale Terrier? Yes No
(If No, Explain)

Have you owned a dog as an adult?
Yes No

Have you owned an Airedale as an adult?
Yes No

What other breeds are you considering?

Describe your understanding of what grooming an Airedale Terrier requires:

Do you plan to have your Airedale Terrier groomed professionally?
Yes No

Anyone in family have allergies?
Yes No
Describe:

What are the positive traits of an Airedale?

What are the negative traits of an Airedale?

Who will be the primary person responsible for the Airedale Terrier?

Daily work hours of primary caretaker.

What is your exercise level on a scale of 1 to 10?
1 = move from bed, to chair, to car, to desk, to car, to couch, to bed
5 = long, brisk walks twice a day
10 = train daily for marathons
Describe specifically:

If you currently have a dog, describe the kind of exercise you currently give your dog:

Describe the kind of exercise you anticipate giving your new dog:

How much off leash exercise will the dog get?

Do you have any experience with obedience training? Yes No
If yes, please describe the method used:

Are you willing to attend a basic obedience course with your new dog?
Yes No

If you wish to adopt an Airedale under the age of three, please give us the name and telephone number of the trainer you will be using for your adopted Airedale's training.
Obedience Trainer
Trainer or Business name:

City and State:

Telephone Number:

Have you had any experience walking a dog who was aggressive towards other dogs while on leash?
Yes No

How will you resolve behavior problems such as chewing, fence jumping, digging, excessive barking, chewing on the furniture, counter surfing, leash pulling, jumping on people, difficult housebreaking?

Which of the following reasons might prompt you to return your dog to rescue?
(Check all that apply)
Excessive barking
Biting
Digging
Divorce
Poor watchdog
Destructive chewing
Move to Smaller Living Quarters
Move Out of State
Occasional accidents indoors
Growling at guests
Excessive vet bills
Shedding
New Baby
Allergies
New spouse/partner doesn't like dog
Aggressive on leash
Doesn't get along with other family pets
Comments:

Do you have an area in your yard the dog can use as a "digging pit?" Yes No

Are you willing to have a member of Rescue visit prior to adoption (by appointment)? Yes No

ADOPTION INFORMATION

Why are you considering offering a rescued Airedale a home rather than purchasing a puppy from a breeder?

Do you prefer
Male Female No Preference

Would you consider the opposite sex if one is more readily available?
Yes No N/A

Age Range

Would you consider a younger or older dog, if one were available and otherwise suitable?
Would consider a younger dog
Would consider an older dog
Will not consider any other age range
Comments:

Would you consider an Airedale mix? We do not rescue mixed-breed dogs, but we are frequently contacted about mixed Airedales that need new homes. If there are no suitable purebred Airedales available in the area, as a courtesy we will forward information about mixed Airedales to those who might be interested.
Yes No

What will your Airedale need to get along with? (Check as many as are applicable)
Other Dogs Cats Indoor Birds Small Rodents Poultry Livestock
Children Women Men
Other(describe)

Would it be okay if the dog is? (Check as many as are applicable)
Shy Not good with cats Not good with children
Untrained Somewhat untrained Not Housetrained In need of ongoing minor medical attention

How long will the dog be without human companionship on an average day?

When you are home, what areas are off limits to the dog? Explain:

Where will the dog stay during the day when no one is home?
inside
outside
in or out through dog door

If allowed inside when no one is home, will the dog have the run of the entire house?
Yes
No

If not, what areas are off limits to the dog when no one is home?
What area(s) of the house will be accessible to the dog when no one is home?

Will the dog be crated when no one is home during the day?
Yes
No

Where will the dog sleep at night?
Inside
Outside
If "inside" will the dog have the run of the entire house?
Yes
No
If not, where will the Airedale be allowed at night?

What areas are off limits to the dog at night?

Will the dog be crated at night?
Yes
No

Would you allow your dog on the furniture?
Yes
No
Comments:

Are you familiar with crate training? Yes No

Do you own a dog crate? Yes No
If yes, what type and size dog crate?

If you would use a crate, in what room would you put the crate?

What arrangements will be made for the dog during extended absences?
Caretaker will come to home Board at Kennel
Board with Vet Board with Groomer
Dog will go along Other (Explain)

Are you planning any trips in the next 90 days where the Airedale will not go along?
Yes No

PET HISTORY

Please List your Current Pets, including animals that visit frequently (you will be asked about prior pets later)

Pet 1: Name, breed/species, age, sex, intact/neutered/spayed, how long you have had the pet and whether it is kept inside, outside, or both.
Pet 2: Name, breed/species, age, sex, intact/neutered/spayed, how long you have had the pet and whether it is kept inside, outside, or both.
Pet 3: Name, breed/species, age, sex, intact/neutered/spayed, how long you have had the pet and whether it is kept inside, outside, or both.
Pet 4: Name, breed/species, age, sex, intact/neutered/spayed, how long you have had the pet and whether it is kept inside, outside, or both.
Pet 5: Name, breed/species, age, sex, intact/neutered/spayed, how long you have had the pet and whether it is kept inside, outside, or both.

Do any of your current animals have medical conditions? (Describe)

Are your current dogs up to date on all shots?
Yes No

Do you currently use heartworm preventative or titer (describe)?

What dogs have you owned that you no longer own?

Past Pet 1: How acquired (breeder, rescue, shelter, stray, etc.,), at what age, how long it lived with you and what ultimately happened to it (death due to accident, ill health or old age; placed with another family or shelter and why; lost and circumstances, etc.)
Past Pet 2: How acquired (breeder, rescue, shelter, stray, etc.,), at what age, how long it lived with you and what ultimately happened to it (death due to accident, ill health or old age; placed with another family or shelter and why; lost and circumstances, etc.)
Past Pet 3: How acquired (breeder, rescue, shelter, stray, etc.,), at what age, how long it lived with you and what ultimately happened to it (death due to accident, ill health or old age; placed with another family or shelter and why; lost and circumstances, etc.)
Past Pet 4: How acquired (breeder, rescue, shelter, stray, etc.,), at what age, how long it lived with you and what ultimately happened to it (death due to accident, ill health or old age; placed with another family or shelter and why; lost and circumstances, etc.)
Past Pet 5: How acquired (breeder, rescue, shelter, stray, etc.,), at what age, how long it lived with you and what ultimately happened to it (death due to accident, ill health or old age; placed with another family or shelter and why; lost and circumstances, etc.)

What type/brand food did/do you feed your dog(s)?

Have you ever given up a dog? Yes No

If yes, please explain.

If you were unable to care for your pets (death, immobilizing disability), what would you do with your dog?

If yours is currently a one-dog household, has your dog ever lived with another large dog?
Yes No N/A

If so, how long has your current dog been the only dog of the house?

When will you be ready for your new dog?

VETERINARY REFERENCES:
List name, location, telephone of all veterinarians used in last five years:
Vet #1 (current or most recent): Name, City and State, Telephone, Name of Pet(s) Seen, Reasons Seen

Vet #2: Name, City and State, Telephone, Name of Pet(s) Seen, Reasons Seen

Vet #3: Name, City and State, Telephone, Name of Pet(s) Seen, Reasons Seen

Vet #4: Name, City and State, Telephone, Name of Pet(s) Seen, Reasons Seen

Vet #5: Name, City and State, Telephone, Name of Pet(s) Seen, Reasons Seen

If you did not fill in a veterinarian reference, state the reason why:

OTHER REFERENCES
These should be the persons most familiar with your current or past dogs (groomer, pet sitters -- professional or family members)
Reference 1 Name:

Relationship:

City and State:

Telephone Number:

Reference 2 Name:

Relationship:

City and State:

Telephone Number:

Have you contacted a Rescue Volunteer in your area?
Yes No

Name of Regional Club Rescue or Individual Rescue Volunteer you contacted.

Were there any Airedales available for adoption through your local Rescue?
Yes No N/A

Have you ever adopted a dog through Airedale Rescue before? Yes No

Name of Regional Club Rescue or Individual Rescue Volunteer who provided your previous Airedale.

Do you understand that rescues are spayed/neutered or have a spay/neuter contract? Yes No

Do you understand that if at any time an adopter cannot keep the animal, it must be returned to Airedale Rescue? Yes No

Would you consider fostering an Airedale? Yes No

There is an adoption placement fee for each dog placed. This is used to help offset any bills incurred by the dog being placed and to defray costs incurred by the next Rescue dog needing aid.

If there is a change in any of the information submitted,
please complete and submit a new questionnaire.

Individuals who adopt an Airedale Rescue dog are contacted periodically for an update to help ensure that the animal successfully adjusts to its new life. If you adopt an Airedale Rescue dog, do you consent to home visits after adoption?
Yes No

Any other information you would like to provide?

A home inspection will be made before any adoption is finalized. If at any time we find information contained in this quesitonnaire to be false, we retain the right to turn down your request to adopt or remove the dog from your premises without a refund of monies paid.

I certify that the information provided in this form is true & correct. I am financially and physically able to care for a pet. I understand that proper food and veterinarian care can be costly and I am able to meet these requirements.

Yes No

I acknowledge that I have completely read this questionnaire, comprehend it fully, know that completing this form does not ensure that a placement will be made and that untruthful answers or failure to comply with the requirements of the adoption contract can result in the forfeiture of any Airedale Rescue dog adopted by me. Airedale Rescue volunteers are authorized to contact the references I have given above. ( Required )

Yes No

Please be sure to complete any field marked as required or the computer will reject the form when you submit it and all of your hard work will be lost.

THIS IS NOT AN ENCRYPTED FORM. IF YOU PREFER, CONTACT ONE OF THE PEOPLE LISTED BELOW AND REQUEST A PAPER FORM.

AFTER YOU SUBMIT YOUR QUESTIONNAIRE, YOU WILL BE TAKEN TO A PAGE CONTAINING YOUR ANSWERS, WHICH YOU SHOULD PRINT FOR YOUR RECORDS . IF YOUR QUESTIONNAIRE IS LOST IN CYBERSPACE, YOU WILL BE ABLE TO MAIL OR FAX YOUR ANSWER SHEET RATHER THAN HAVING TO COMPLETE ANOTHER QUESTIONNAIRE.

If you have not received an acknowledgment that your form has been received within 24 hours,
please contact:
Oklahoma Airedale Rescue at Oklahoma@AiredaleTerriers.org