Subject: 



Name of Applicant:     Age: 
Name of Co-Applicant:  Age:  
E-mail Addr:          

Street:   
City:      State:  Zip: 

Home Phone:  

Mailing Address: 
(if different) 

Applicant's Employer: 
Position Held:         Phone: 

Co-Applicant's Employer: 
Position Held:            Phone: 

Veterinarian:      
Address:         Phone: 

Are you interested in adopting: Male 
                                Female
                                Either

Age you are interested in:      Two Dogs
                                Mixes
                                Special Needs
                                Elderly(8 and Older)

Age you are interested in:      Less than 18 months 
                                18 months to 6 years
                                Older than 6 years
                                Any Age

Reason?:


1. Explain why you want to adopt a Scottie
(companion, guard dog, gift, etc.):


2. Do you live in a: House  
                     Apartment
                     Duplex
                     Condominium
                     Townhouse 
 	             Farm

2a. Do you Rent or Own? Rent		
		        Own  

3. Do you have a fenced yard? Yes 
                              No

   If your answer is "Yes", what type of fence?
			      Wood 
			      Chain Link
			      Electric	

   If your answer is "No", how will you excercise your Scottie?
       

   Who will supervise your Scotties outdoor activities?
                   
            

    Do you have a pool?      Yes 
                             No

    Do you live near a river or pond?Yes 
                                     No

4. Where will this dog stay during the day?


5. Where will this dog be kept at night?


6. How many Adults/Ages live in your home?   


7. How many Children/Ages live in your home? 

 
8. Is anyone home during the day? Who?:


9. Who will be responsible for taking care of the Scottie/Age?:


10. How many hours will the dog be alone per day? 

11. Who will care for your Scottie while you are on vacation?

12. If you move, what will you do with this Scottie?:


13. Are you willing to take responsibility for this Scottie
    for the next ten years or more? 
                    Yes 
                    No

14. How much do you think it will cost to take care for this Scottie
each year(please consider cost of vet care, food, grooming, license, etc.)?:


15. Pets you currently own:
Type/Breed       Sex    Age    Spayed/Neutered   


16. Other pets you have owned:
Type/Breed      Age    Cause of Death 


17. How did you hear about Wee Beasties Scottie Rescue?



18. References (please list two)
Name                Address                  Phone#        Email   

I ACKNOWLEDGE THAT ALL THE INFORMATION CONTAINED ON THIS APPLICATION FORM IS TRUE AND CORRECT. I UNDERSTAND THAT ANY MISREPRESENTATION MAY RESULT IN THE REMOVAL OF THE ADOPTED SCOTTIE FROM MY HOME BY THE WEE BEASTIES SCOTTIE RESCUE.

Form may be submitted on-line by clicking on the "SUBMIT" button below
or you can print and complete the application and send by mail to:
Martha Straw
81 Anchorage Drive
Newport News, VA. 23602