Scottish Terrier Rescue Northwest

Use the following text blocks and check boxes to complete your application.

Please be sure to include your email address so that we can contact you.

Name
Street Address
Address (cont.)
City
State
Zip Code
Work Phone
Home Phone
E-mail

Are you interested in adopting:

Male only Female only Either sex

Would you consider adopting a Scottie Mix?

Yes
No

Would you consider adopting an older Scottie (over 8 years old), a terminally ill dog, or a Scotty who has special needs (like blindness, deafness, a medical condition such as Cushings that may require daily attention)?

Yes
No

Would you take two Scotties?

Yes
No

Have you ever previously owned either a show or pet Scotty, or had a Rescue Scotty? Please explain below.

Yes
No

Do you live in a:

House
Apartment
Condominium
Other

Do you Rent or Own?

Rent
Own

Do you have a fenced yard?

Yes
No

Do you have a pool or any other open body of water anywhere on your property?

Yes
No

Please indicate the age of the primary caregiver.

Unspecified
Under 15
15-25
26-55
56-75
76 - older

Do you have minor children living at home?

Yes
No

Will this dog come in frequent contact with children?

Yes
No

Number of Adults in Household (over 18)?

Where will the dog stay during the DAY?

Where will the dog stay at NIGHT?

Typical Vacation Arrangements

Please list other pets you CURRENTLY own:

Your Veterinarian's Name (As a Reference):

Personal References (please provide two):