WIRE FOX TERRIER RESCUE ADOPTION APPLICATION

Wire Fox Terrier Rescue Great Lakes covers those areas in which we have support volunteers for the dogs we place. Generally this includes MICHIGAN, northern OHIO, and northern Indiana. We have been able to successfully place a few dogs in CONNECTICUT due to the efforts of a great friend there who is able to lend a hand. If you live outside of these areas and wish to adopt a rescue Wire please click on of the links provided. Click this link to the American Fox Terrier Rescue website, which has contact information and resources about rescue across the country. Click this link to the Wire Fox Terrier Rescue Midwest website, which serves the following states, IOWA, MISSOURI, N. Dakota, S. Dakota, Wisconsin, Kansas, and southern INDIANA. Thank you!

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Most fields require a response!

TODAY'S DATE:  
Applicant
First Name:  (required)    		Last Name:  (required)  
Co-Applicant
First Name:   		Last Name:  
Your E-Mail  (required)   Fax Number   
Street Address  (required)
Mailing Address  
City   State/Province  

Zip/Postal Code   Country
Day Phone #    Evening Phone #  
Accept collect calls?   Yes   No   Day only   Evening Only
How did you find this Application Form?

RESIDENTIAL INFORMATION
House Condo Apartment Ranch or Farm 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)
Fencing Type
If other, describe 		Fence Height
Surface of outside dog area Length & Width of Dog Yard
Describe provisions for outside water & shelter
Does a door from the house open directly to the fenced yard?
Yes No N/A 		Dog Door?
Yes No Willing to Install
Do you have a swimming pool? Yes No Can the dog get into the pool from the dog yard? Yes No
Does your town have a leash law?
FAMILY INFORMATION
List all household members, including frequent visitors, and their approximate ages
(Humans only -- You will be asked about pets later in the form)
Do you plan to add to your family in the next five years?
Yes No
Why do you want an Wire Fox Terrier?
Do all family members want an Wire Fox Terrier? Yes No
(If No, Explain)
Describe your family's typical day and how your dog(s) fit into that day (or how you anticipate your new dog fitting in if you don't currently have a dog).
Is this your first Wire Fox?
Yes No 		Aware of grooming needs?
Yes No 		Anyone allergic to dogs?
Yes No
What do you know about about Wire Foxs? Include titles of books read and describe other sources of information.
How do you feel about muddy footprints on carpet & bedspreads?
Do you have an area in your yard the dog can use as a "digging pit?" Yes No
Describe the kind of temperament you are looking for in a dog.
(i.e., calm, energetic, aloof, affectionate, etc.)
What qualities appeal to you about the Wire Fox?
Who will be the primary person responsible for the Wire Fox Terrier? Daily work hours of primary caretaker.
Do you have any experience with obedience training? Yes No If so, please specify:
Are you willing to have a member of Rescue visit prior to adoption (by appointment)? Yes No
ADOPTION INFORMATION
Do you prefer
Male Female No Preference 		Would you consider the opposite sex if one is more readily available?
Yes No N/A
Age Preference
What will your Wire Fox 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)
How long will the dog be alone on an average day? Where will the dog stay during the day when alone?
Where will the dog stay at night?
What activities will you share with your dog? (Check as many as are applicable)
Walking Hiking Obedience Classes Agility Flyball Fishing Hunting Swimming
Herding Frisbee Playing Fetch
Other(describe)
What will you do if the dog chews one of your shoes?
What will you do if the dog marks in the house?
Estimate monthly expenses for each dog: Estimate annual medical costs for each dog:
Would you be willing to take a dog with minor health problems?
Yes No
Are you familiar with crate training? Yes No Do you own a dog crate? Yes No
If yes, what type and size dog crate?
Why or why not use a 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)
PET HISTORY
List all animals currently in your household (type, age, sex, neutered/spayed)
(Include animals that visit frequently)
Do any of your current animals have medical conditions? (Describe)
Where and how often are the dogs fed? What brand of dog food?
Are your current dogs up to date on all shots?
Yes No 		What brand of heartworm preventative are you presently using?
Describe previous dogs you have owned, how long they lived and what ultimately happened to them.

You would consider giving up your dog if
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 arrangements have you made?
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?  
List name, address, telephone of your veterinarian   Nearest Emergency After-Hours Vet & Phone Number
Dog Groomer (Business name/phone number)
PLEASE LIST ONE REFERENCE NOT RELATED TO YOU (Name, Address, Telephone)
If possible, list a neighbor and someone else familiar with your current or past pets

Have you Contact National Rescueed a Rescue Volunteer in your area? 
  Yes No

Name of Regional Club Rescue or Individual Rescue Volunteer you Contact National Rescueed.  
Were there any Wire Foxs available for adoption through your local Rescue?
   Yes No N/A 		Have you ever adopted a dog through Wire Fox Rescue before?   Yes No
Name of Regional Club Rescue or Individual Rescue Volunteer who provided your previous Wire Fox.   Have you adopted companion animals from other shelters or rescue groups?
Yes No
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 Wire Fox Rescue? Yes No
Are you aware that if Rescue places a dog with you, you will be asked to make a donation, which helps defray costs such as shelter fees, veterinary care, etc.?
Yes No
If there is a change in any of the information submitted,
please complete and submit a new application.
Individuals who adopt an Wire Fox Rescue dog are Contact National Rescueed periodically for an update to help ensure that the animal successfully adjusts to its new life. If you adopt an Wire Fox Rescue dog, do you consent to home visits after adoption?
  Yes     No
Any other information you wish us to consider in placing one of our Wire Foxs with you?

A home inspection will be made prior to adoption and on a random basis following adoption. If upon inspection we find that information contained in this application to be false, we retain the right to turn down your application or remove the animal 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. Type YES or NO (required)



I acknowledge that I have completely read this questionnaire, comprehend it fully, know that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application or the adoption contract can result in the forfeiture of any Wire Fox Rescue dog adopted by me. Type YES or NO (Required)




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After you submit the application, you will be taken to a page containing a copy of your answers. Please print that page for your records so that you can forward it in case something happens to your application. Thank you!