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Application for Adoption of a Rescue Cairn or Cairn Mix

Thank you for your interest in adopting a rescue Cairn terrier or Cairn mix ("Cairns"). Prior to submitting this application, you should become familiar with how our Adoption Process works and review our Adoption Contract form to ensure you agree with its terms. You should also review our Frequently Asked Questions (FAQs). Please note that we do NOT place dogs outside of the continental United States.

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Please answer all questions in this application so that we may determine which rescue Cairn in our program is best suited for your household. All information is confidential as stated in our Privacy Policy. Please note that you must be at least 18 years old to adopt a rescue Cairn from us and that incomplete applications may be rejected or delayed.

A. Personal Information
*Required Field
*Applicant Name:
Co-Applicant Name (if any):
*Address:
*
*E-mail:
Home Phone:
Work Phone:
Hours applicant is at work:
May we call applicant at work?   Yes    No
Best time of day to call applicant:
Times when we should NOT call:
How often does applicant check e-mail?  
Has applicant placed an application with any other rescue group?   Yes    No
If Yes, for what breed and what is the status of the application?


B. Your Preferences

 1. What gender Cairn are you willing to adopt?  
 2. What age Cairn would you consider (check all that apply)?
Puppy (under 1 yr)
Youngster (1-3 yrs)
Teenager (4-7 yrs)
Mature (8-10 yrs)
Senior (11+ yrs)
 3. Would you consider a Cairn mix?   Yes    No
 4. Would you be willing to adopt a Cairn with any of the following special needs (check all that apply)?
Skin allergies
Insulin-controlled Diabetes
Hypothyroid (med-controlled)
Seizures (med-controlled)
Deafness
Partial blindness
Total blindness
Condition requiring a vet-prescribed diet
Dry Eye (requiring prescription eye drops twice daily)
Other:  
 5. Would you consider a Cairn that still requires housetraining?   Yes    No
 6. What energy level would you prefer in your Cairn?  
 7. Would you consider a puppy mill survivor that may be shy?   Yes    No
 8. Are you willing to work with a Cairn that has behavior issues such as (check all that apply):
Excessive barking
Escaping
Digging
Separation Anxiety
Aggression towards other dogs
 9. Are you willing to work with a Cairn that needs obedience training?   Yes    No
10. What would you do if the Cairn you adopt starts to challenge you, nips you, or nips a member of your family?

11. Cairns can live well into their teens. Are you willing to take responsibility for this dog for the next 10 or more years?   Yes    No
12. Have you made any arrangements to ensure that your pets will be cared for in the event that you should die unexpectedly?
Yes:
No
Not yet, but plan to do so
13. Have you considered how much it costs to own a dog? (e.g. routine veterinary care, food, grooming, licensing, extraordinary vet care in case your Cairn should get sick, etc.)   Yes    No
14. Did you read our Adoption Contract?   Yes    No
15. Did you review the Cairns for Adoption on our website?   Yes    No
16. If so, are you interested in any of our currently available dogs?   Yes    No
17. If yes, please specify which dog(s):
18. Have you been in touch a CRUSA representative about this Cairn(s) (not required, but if so, please specify)?

19. If any Cairn listed in response to Question 13 is being fostered in a state other than the state you live in and you were approved to adopt it, how do you plan to transport it to your home?
Can drive part of the way to get him
Can drive all the way to get him
Can fly to where he's being fostered and bring him back in the airplane cabin
Can pay to have him shipped in a crate in the plane's cargo
(actual cost is $260 to $300 depending on dog's weight)
Other:
20. Please provide any other information about you or your family that might help us find the right match for you:


C. Household Information

 1. Applicant Age:
 2. Co-Applicant Age:
 3. Applicant's occupation:
 4. Co-Applicant's occupation:
 5. Number of adults in the household:
Men:
Women:
 6. Number of children under 18 years of age in the household: 
 7. Ages of children in the home:

Age of child # 1:
Age of child # 2:
Age of child # 3:
Age of child # 4:
Age of child # 5:
 8. Please note that for the safety of our dogs and of our applicants’ children, Cairn Rescue USA will not place a dog with a family that has children under the age of 7 years unless the family can prove to our satisfaction one of the following: (i) that the parents have owned Cairns, Westies, and/or Scottish-terriers in the past; (ii) that the child has been raised with Cairns, Westies and/or Scottish terriers, knows how to interact with a dog, and is not afraid of dogs, and/or (iii) that the family is involved in dog rescue. For the reasons behind our policy, please refer to our FAQs. If you have children under the age of 7 years and believe you meet these criteria, please explain:

 9. What experience have your children had with dogs?

10. How much responsibility will the child(ren) have in the care and management of the Cairn?  
11. How much adult supervision will the dog and the child(ren) have?  
12. Are there children under 18 years of age who frequently visit the household (i.e., grandchildren, stepchildren, frequent houseguests, neighbors, babysitters)?   Yes    No
13. If Yes, please list by name, age, relationship, and frequency of visitation:

14. What experience have these children had with dogs?

15. Are any members of your household allergic to dogs, hair, or dust or have asthma?   Yes    No
16. If Yes, please describe:
17. For whom are you adopting the Cairn?    
18. Does everyone in your household approve of getting a Cairn?   Yes    No
19. If No, please explain:
20. Please check all that apply:
I have worked or volunteered with an animal shelter before
I have volunteered with a dog rescue group before
I have adopted a rescue dog before
I have taken a dog I owned to obedience classes before
I show dogs in conformation or performance events
I belong to an online cairn terrier/terrier list
None of the above
21. If you checked any of the above, please specify:


D. Pet Ownership

 1. Why do you want to adopt a Cairn?
 2. Why do you want to adopt a rescue dog?

 3. If you have done any research with respect to adopting a rescue dog, please specify:

 4. What do you think are the most important responsibilities of dog ownership?

 5. Have you previously owned a Cairn?   Yes    No
 6. If you have never owned a Cairn, what research have you done to ensure that this breed is the proper one for you?

 7. Do you understand that Cairns adopted through Cairn Rescue USA will be spayed/neutered prior to adoption?   Yes    No
 8. How many dogs have you owned in the past 10 years?  
 9. Please list your current pets by name, breed/type/species, age, gender, spay/neuter condition, and current health:

10. Please describe the pets that are no longer with you. List breed or type, age, and why they are no longer with you:

11. If you currently have more than one dog, please describe how they get along:


E. Home Information

 1. In what type of home do you live?    
 2. If you live in a condominium or apartment, do you live on the ground floor or an upper level?  
 3. If you live in a single family or townhome, does it have stairs in it?   Yes    No
 4. If so, please describe where they are and how often the dog will need to use them:

 5. Does your home have a deck or balcony?   Yes    No
 6. If so, would a Cairn fit through the space between the railings?   Yes    No
     Approximate height of railing:
 7. Do you rent or own your home?   Rent    Own
 8. If you rent, how long have you lived in your current home?  
 9. If you rent, does your landlord allow pets?   Yes    No
10. If you rent, are you willing to provide CRUSA upon request with a copy of your lease or a notarized statement from your landlord authorizing pet occupancy?   Yes    No
11. Do you have a yard or patio for your Cairn to use?   Yes    No
12. If Yes, is the area fenced?   Yes, fully    Yes, but only partially    No
13. If fenced, of what material is the fence made?    
14. Height of fence in feet:  
15. Have you inspected the fence for holes that a Cairn could crawl or dig through?   Yes    No
16. If there is not a fenced yard/patio for your Cairn to use, will you provide leashed walks?   Yes    No
17. If so, how often?
18. Who will be responsible for the daily care of your Cairn (feeding, walking, training, etc. -- check all that apply)?
Myself
My spouse
My child(ren)
Other:  
19. Will anyone be home during the day?   Yes    No
20. If so, who will be home and what will their responsibilities for the Cairn be?

21. How many hours a day will your Cairn be:
Indoors?
Outdoors?
22. When your Cairn is outside (please check any and all that apply):
My Cairn is/will be kept in a fully fenced yard.
My Cairn is/will be kept on a leash if there is no fence or if there is only a partial fence.
I walk my dogs off-leash when we go out for walks; they never run away.
Once I have taught my dogs to heel, stay and come, I no longer use a leash when I take them for walks.
I always use a leash to walk my dogs outside, unless the area is fully-fenced.
I use an electronic fence.
I let my dog run loose in unfenced areas; I know my dog will come when called.
I do not have a fence and use a tie up and leave the dog alone to do its business.
I do not have a fence and use a tie up but I stay outside supervising the dog.
I take my dog to the local dog park.
Other:  
23. How many hours a day will your Cairn be left alone?  
24. When alone, where will your Cairn be kept?    
25. Where will your Cairn sleep at night?
26. If necessary, how will you housetrain your Cairn?

27. Do you have a crate of adequate size for your Cairn (i.e. Varikennel 200) or are you willing to provide one prior to adoption?
  
Yes    No
Note: A crate is used by the Cairn as a den, for time alone, feeding, travel, sleeping, etc. It is NOT meant to be used to confine the Cairn all day long while its owner is at work. An exercise pen or a babygated area should be used instead.
28. Are you willing to have your home visited by a CRUSA representative (by appointment) to do the home safety inspection required by CRUSA’s application process?   Yes    No
29. Are you able and willing to make an adoption donation if you adopt a Cairn or Cairn mix through rescue?   Yes    No

F. References

*Required Field

 1. Personal References.
 We require three personal references, only two of which should be a family member. Please indicate your relationship to your reference (family member, friend, neighbor, co-worker, etc.). All references must be 18 years of age or older.

  a. Reference 1
*Name:
*Address:
*City:
*State:
*Zip:
*Home Phone:
Work Phone:
(with permission)
E-mail:
*Relationship:
*Best time(s) to call:

  b. Reference 2
*Name:
*Address:
*City:
*State:
*Zip:
*Home Phone:
Work Phone:
(with permission)
E-mail:
*Relationship:
*Best time(s) to call:

  c. Reference 3
*Name:
*Address:
*City:
*State:
*Zip:
*Home Phone:
Work Phone:
(with permission)
E-mail:
*Relationship:
*Best time(s) to call:

 2. Veterinary Reference(s).
 If you have used your current vet for less than two years, please include an additional veterinary reference. If you do not currently have a vet, either (i) provide information for the vet you will be using when you adopt your Cairn, or (ii) if you have had pets in the past 15 years, list the information for the vet that cared for them.

  a. Vet Reference 1
Name of Practice:
*Doctor's Name:
*Address:
*City:
*State:
*Zip:
*Phone:

  b. Vet Reference 2
Name of Practice:
Doctor's Name:
Address:
City:
State:
Zip:
Phone:


G. Where You Heard About CRUSA

 1. Where did you hear about us?
  

H. Agreement

  1. You give Cairn Rescue USA (CRUSA) permission to call your listed references, including your veterinarian(s), to determine responsible pet ownership.

  2. If you have included a work telephone number for any of your references, you are representing that they may receive telephone calls at their place of employment.

  3. You agree to notify CRUSA at Adoptions@CairnRescueUSA.com once you are no longer looking for a Cairn.

  4. You certify that you have read our Adoption Process and our Adoption Contract and agree to abide by their terms, including with respect to the requested adoption donation amounts and the non-refundable nature of donations.

  5. You represent that the information that you have provided on this form is the truth to the best of your knowledge and belief.

  6. You certify that you have never been convicted of animal cruelty, neglect or abandonment by a court of law or other governmental authority.

  7. You understand that your execution of CRUSA’s adoption contract will be required prior to adopting any rescue Cairn. We may also require identification showing your current address, such as a driver's license.

Please make sure the application is complete and you have entered ALL REQUIRED FIELDS before pressing the "Send" button below. Incomplete applications may be rejected or delayed. Failure to complete required fields may cause you to have to RE-ENTER the ENTIRE application depending on your browser.


    

Last Update: 16-July-2006
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Web Developer: Veronica A. Hudak-Moe