Adoption Application Please take a few moments to review our Adoption Agreement before filling out application. Adoption Application "*" indicates required fields A. Personal InformationApplicant Name* First Last Co-Applicant Name (if any) First Last Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email* Best Phone Number to Reach You*Hours applicant is at work Best time of day to call applicant How often does applicant check e-mail? Everyday 2-3 times/week Once a week Once a month Rarely Has applicant placed an application with any other rescue groups? Yes No If yes, for what breed and what is the status of the application? B. Your PreferencesWhat gender Cairn are you willing to adopt?* No preference Male only Female only Prefer male, but would consider female Prefer female, but would consider male 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) Would you consider a Cairn mix?* Yes No 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: If other, please specify: Would you consider a Cairn that still requires housetraining?* Yes No What energy level would you prefer in your Cairn?* No preference High Energy Couch Potato In the Middle Would you consider a puppy mill survivor that may be shy?* Yes No Are you willing to work with a Cairn that has behavior issues such as:* Excessive barking Escaping Digging Separation anxiety Aggression towards other dogs None of these check all that applyAre you willing to work with a Cairn that needs obedience training?* Yes No What would you do if the Cairn you adopt starts to challenge you, nips you, or nips a member of your family?*If you have made arrangements to ensure your pets will be cared for in the event of your death, please explain:*Are you interested in any of our currently available dogs?* Yes No Not applicable If yes, please specify which dog(s):* We do not ship dogs to their adoptive homes. How far are you willing to drive to adopt a new dog?* Have you been in touch with a CRUSA representative about this Cairn(s)?Not required, but if so, please specify: Please provide any other information about you or your family that might help us find the right match for you:C. Household InformationApplicant Age*Co-Applicant AgeApplicant's Occupation* Co-Applicant's Occupation List all family members and their ages*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:What experience have your children had with dogs?How much responsibility will the child(ren) have in the care and management of the Cairn?* Not applicable None Minimal Some Maximum How much adult supervision will the dog and the child(ren) have?* Not applicable None Minimal Some Maximum Are there children under 18 years of age who frequently visit the household?*(i.e, grandchildren, stepchildren, frequent houseguests, neighbors, babysitters) Yes No If yes, please list by name, age, relationship, and frequency of visitation:What experience have these children had with dogs?Are any members of your household allergic to dogs, hair, or dust or have asthma?* Yes No If yes, please describe: For whom are you adopting the Cairn?* Myself My spouse My child My family Other: If other, please specify: Does everyone in your household approve of getting a Cairn?* Yes No If no, please explain: 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 mix list If you checked any of the above, please specify:D. Pet OwnershipWhy do you want to adopt a Cairn?*Why do you want to adopt a rescue dog?*If you have done any research with respect to adopting a rescue dog, please specify:*What do you think are the most important responsibilities of dog ownership?*Have you previously owned a Cairn?* Yes No If you have never owned a Cairn, what research have you done to ensure that this breed is the proper one for you?*Do you understand that Cairns adopted through Cairn Rescue USA will be spayed/neutered prior to adoption?* Yes No How many dogs have you owned in the past 10 years?*Please list your current pets by name, breed/type/species, age, gender, spay/neuter condition, and current health:*Please describe the pets that are no longer with you. List breed or type, age, and why they are no longer with you:*If you currently have more than one dog, please describe how they get along:*E. Home InformationIn what type of home do you live?* Single family Townhome Condominium Apartment Mobile home Other: If other, please specify:* If you live in a condominium or apartment, do you live on the ground floor or an upper level?* Not applicable Ground floor Upper Level If you live in a single family or townhome, does it have stairs in it?* Yes No Not applicable If yes, please describe where they are and how often the dog will need to use them:* Does your home have a deck or balcony?* Yes No If so, would a Cairn fit through the space between the railings?* Yes No Approximate height of railing:* Do you rent or own your home?* Own Rent If you rent, how long have you lived in your current home?* If you rent, does your landlord allow pets?* Yes No 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 Do you have a yard or patio for your Cairn to use?* Yes No If yes, is the area fenced?* Yes No If fenced, of what material is the fence made?* Not applicable Wood Chain Link Other: If other, please specify:* Height of fence in feet:*Have you inspected the fence for holes that a Cairn could crawl or dig through?* Yes No If there is not a fenced yard/patio, how many leashed walks will you provide each day?* Who will be responsible for the daily care of your Cairn (feeding, walking, training, etc.)?* Myself My spouse My child(ren) Other: check all that applyIf other, please specify:* Will anyone be home during the day?* Yes No If so, who will be home and what will their responsibilities for the Cairn be?*How many hours a day will your Cairn be indoors:* How many hours a day will your Cairn be outdoors:* When your Cairn is outside:* My cairn is/will be kept in a fully fenced yard My cairn is/will be kept on a leash 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: Please check any and all that applyIf other, please specify:* How many hours a day will your Cairn be left alone?* When alone, where will your Cairn be kept?* Run of the house In a crate Confined to a room Garage Basement Other: If other, please specify:* Where will your Cairn sleep at night?* If necessary, how will you housetrain your Cairn?*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.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 Are you able and willing to make an adoption donation if you adopt a Cairn or Cairn mix through rescue?* Yes No F. ReferencesPlease provide three personal references and provide a phone number where they can be best reached! Only two references 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.Reference 1:* First Last Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Best Phone Number to Contact*HiddenWork Phone Number (with permission)Email* Relationship* Best time(s) to call* Reference 2:* First Last Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Best Phone Number to Contact*HiddenWork Phone Number (with permission)Email* Relationship* Best time(s) to call* Reference 3:* First Last Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Best Phone Number to Contact*HiddenWork Phone Number (with permission)Email* Relationship* Best time(s) to call* 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.Vet Reference 1:* First Last Name of Practice* Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone Number*Vet Reference 2: First Last Name of Practice Address Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone NumberG. Where You Heard About CRUSAWhere did you hear about us? Internet search engine Cairn terrier chat/email list Link from another rescue site Shelter Rescue representative business card Dog show/pet event Friend Other: If other, please specify: H. AgreementConsent*You give Cairn Rescue USA (CRUSA) permission to call your listed references, including your veterinarian(s), to determine responsible pet ownership. 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. You agree to notify CRUSA at Adoptions@CairnRescueUSA.com once you are no longer looking for a Cairn. 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. You represent that the information that you have provided on this form is the truth to the best of your knowledge and belief. You certify that you have never been convicted of animal cruelty, neglect or abandonment by a court of law or other governmental authority. 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. I agree.PhoneThis field is for validation purposes and should be left unchanged. Stay up to date by receiving our Email NewsletterJoin our mailing list to receive the latest news and updates from Cairn Rescue USA. SIGN UP! 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