CPCRN : Adoption Application

Col. Potter Cairn Rescue Network

Cairn Terrier or Cairn Terrier Mix
Adoption Application

Thank you for considering a Cairn Terrier or a Cairn Terrier mix as an addition to your home. We pledge to do all that we can to help your search be successful.

You can also help us by answering this "getting to know you" application with detailed answers. ONLY through your complete answers will we be able to learn about you and your household. We will then be better able to determine what Cairn would be best suited for you.

The Fine Print

Col. Potter Cairn Rescue Network (CPCRN) reserves the right to decide the placement of their rescue Cairns. CPCRN reserves the right to deny placement of their rescue Cairns.

By filling out the below application, you agree to notify CPCRN once you no longer are looking for a Cairn. You also agree to notify us if there are any changes in your household, which would relate to questions you have answered in this application.

You MUST be 21 years of age or older in order to apply to adopt a rescue Cairn or Cairn mix through CPCRN. Photo identification may be required upon adoption.

ATTENTION!! PLEASE READ THIS PRIOR TO FILLING OUT YOUR APPLICATION:
Applications that are submitted and are incomplete will be automatically rejected. Our application e-mail program DOES NOT ALLOW us to go back into your application at a later time and change or add additional information that was not entered prior to hitting the "Submit" button. THEREFORE, PLEASE review the application prior to filling it out and have all necessary names, addresses, phone numbers, and e-mail addresses handy. Then, PLEASE review your reference information, and verify that there have been no typographical errors. Thank you kindly for taking the extra time here. It is greatly appreciated.

IMPORTANT: Before applying to adopt any dog, PLEASE read the Adoption FAQs (Frequently Asked Questions) section. If you have children under the age of 12 living in your home or who visit frequently, it is especially important that you read our policy on adopting to families with children. Please read this prior to completing your Application.

Free to Good Home?


Adoption Application

After completion and submission of this application, you should receive a copy via e-mail shortly. Be sure to enter a valid e-mail address before submitting, otherwise the application will not go through.
Personal Information
* Required field
* Enter the name of the person who is filling out this application (YOUR name):
Are you the applicant? Yes No
If NO, indicate why you are filling out this application for another party:
	Not applicable
	Applicant does not have a computer
	Applicant submitted a handwritten application for transfer
	Telephone application was taken
	Other:
NOTE: If you are transferring an application as a courtesy to the applicant, then the transfer must match the original word for word AND the original handwritten copy must be sent to CPCRN.
* Applicant Name:	Title	* First Name	* Last Name
Co-applicant Name:	Title	First Name	Last Name
* Address: Please DO NOT use a PO Box - home address is necessary
	* City	* State/Province	* Zip Code
	Home Phone	Work Phone	Cell Phone
	* E-mail @		Driver's License# (needed upon adoption)
Additional geographical information which will help rescue workers know where you live.
List the closest airport and approximate distance from your home:
Indicate the BEST time for a Rescue Contact to call you:
Indicate a time when a Rescue Contact should NOT call you:
Would you be willing to accept a collect call from Cairn Rescue if necessary? Yes No
Please list any other Rescue(s) and/or Shelter(s) from which you have recently, or are currently in the process of applying to adopt:
Have you ever applied to adopt from CPCRN before? Yes No
If Yes, what was the result?	�Application was approved, but I did not adopt �Application was approved and I adopted from CPCRN �Application was denied �Application was placed on hold �I withdrew my application
When did you last apply to/adopt from CPCRN? /
Household Information
MEMBERS:
List all ADULT FAMILY members who currently reside in the household by name, age, and occupation, INCLUDING YOURSELF:
1. Name: Age: Occupation: 2. Name: Age: Occupation: 3. Name: Age: Occupation: 4. Name: Age: Occupation:
List all other adults (NON-FAMILY) who reside in your household by name, age, and relationship to you:
1. Name: Age: Relationship: 2. Name: Age: Relationship: 3. Name: Age: Relationship: 4. Name: Age: Relationship:
List all RESIDENT children under 18 years of age by name, age and relationship to you:
1. Name: Age: Relationship: 2. Name: Age: Relationship: 3. Name: Age: Relationship: 4. Name: Age: Relationship:
List other children under 18 years of age who VISIT FREQUENTLY by name, age, relationship, frequency, and typical duration of visitation:
Name Age Relationship Frequency Duration of visit 1. 2. 3. 4.
ACTIVITY LEVEL: List the hobbies/activities in which you and your family participate:
What energy level you would prefer your Cairn to have?	Mellow Sofa-buddy Energetic Somewhere in between
Do any members of your household have allergies or asthma? �Yes ��No
If so, list the members and describe the reactions to animals:
Do any members of your household need a "special" Cairn to assist any with special needs members of your household (i.e. blind, deaf, disabled)?			�Yes ��No
If so, explain:
For whom are you adopting the dog?	Myself�� My Spouse�� My Child�� Other
Does everyone in your household know that you are applying for a rescue dog and do they all agree to owning a dog?			�Yes ��No
If you answered NO, explain:
Pet Ownership

Why do you want to adopt a Cairn Terrier or Cairn Mix?
What do you think are the most important responsibilities of dog ownership?
What is the ONE most important factor you are seeking in a Cairn?
What specific traits/characteristics are you looking for in a Cairn that would make him/her a perfect match for your home?
Former Pets

Have you ever previously owned a dog or cat? �Yes ��No
How many dogs have you owned in the past 15 years?
How long has it been since you've had a pet in your home other than to visit?
Describe the pets that are no longer with you. List breed or type, age, and why they are no longer with you. BE SPECIFIC:
IF you previously owned a Cairn/Cairn-Mix, when was it?
What research, if any, have you done on the Cairn breed to insure that this is the proper breed for you?
Do you understand that dogs received through this site will be spayed/neutered prior to adoption?			�Yes ��No
Current Pets

List all current pets by Name, Breed/Type/Species, Age, Gender, Spay/Neuter condition, and current health:
Describe the temperament of each DOG you currently own (by name):
1. Name: -	Alpha Submissive Docile Active Aggressive
2. Name: -	Alpha Submissive Docile Active Aggressive
3. Name: -	Alpha Submissive Docile Active Aggressive
4. Name: -	Alpha Submissive Docile Active Aggressive
Your Home

The following questions are asked to help our Placement Specialists determine the correct rescue dog for your home.
In what type of home do you live?
Is your home a Single story Bi-level 2 Story Other
If you live in a Condo or apartment, do you live on the ground floor or an upper level?		Ground Floor Upper Level
Do you have a balcony? �Yes No
Do you have a deck? �Yes �No
If so, describe the type and height of the railing:
Describe any stairs that you have in your home or leading to it (in detail):
Describe the size of your home (very small, small, medium, large). Include square footage or number of rooms:
Do you rent or own your home? �Own��Rent
If you rent, does your landlord allow pets? �Yes ��No
If you rent, provide the following information:
Landlord Name:
Address:
	City	State/Province	Zip Code
	Phone
How would you describe the area in which you reside? Urban Suburban Semi-rural Rural
Outdoors

Does your home have one or more of the following?	Yard�� Patio�� Atrium�� Other
If you have a yard, is it fenced? �Yes ��No
If yard is fenced, describe the materials & height of fence, and size of yard:
Do you have electric (hidden/underground) fencing? �Yes ��No If No, do you plan to install electric fencing? Yes No
If you do not have a fence, describe how you plan to keep your dog from roaming off of your property:
Do you understand and agree that a Cairn should NEVER be left off-leash outside for even a moment UNLESS it is inside a securely fenced area? �Yes ��No
Caring for Your New Rescue Addition
Where will the dog be kept during the day?
INDOORS:�	�Loose��Crated��Basement��Other�
OUTDOORS:�	�Loose��Fenced Yard��Tied Up�� �Kennel Run��Garage��Other�
Who will be responsible for feeding, housebreaking/training?	Myself My Spouse My Child Other
Are you willing to take your dog for obedience lessons if necessary? Yes No
Will anyone be home during the day? �Yes ��No
If so, who will be home and what are their responsibilities with a new dog?
Describe the exercise schedule you will have for your dog:
How many hours a day will the dog be left INSIDE unattended?
How many hours a day will the dog be left OUTSIDE unattended?
Describe the activity and arrangements in detail:
How frequently will the adults be away from home on business trips, vacations, or other activities?
When you are away on trips, where will the dog be kept?	�Home, someone comes over to feed��Pet sitting service �Board at dog kennel��Other�
After the dog has been adequately house-trained, where will it sleep at night?
What do you intend to feed the dog?
Would you consider adopting a dog that is not yet housebroken? �Yes ��No
If YES, how will you housebreak the dog? (provide details):
Rescue Wish List

What gender dog do you prefer?
If you selected a gender preference, would you still consider a Cairn of the opposite gender? Yes No
What age dog do you prefer? (Often the exact age of rescue dogs is unknown)	No Preference Puppy Youngster (1-3) Teenager (4-7) Mature (8-10) Senior (11+)
Do you have a weight preference or requirement for the dog? �Yes ��No
If YES, explain:
Special Needs dogs could be of any age. They could be Cairns with a vision or hearing loss, or have some other medical condition. They could be dogs in their twilight years who need a loving home for the rest of their lives.
Would you consider a special needs Cairn? Yes No
If YES, check all you would consider:	Hearing Loss Blindness Limb Loss Allergies Health Problems Other:
Would you consider a Cairn Mix? �Yes ��No
How do you anticipate transporting your dog to your home, if approved?	Drive to any location Have dog flown or shipped to me Fly to pick up dog Pay for volunteer transport if available Require dog close to my home (list your one-way driving mileage limit):
List any other specifics/details about you/your family that will help us match a Cairn/Cairn-Mix with your home:
References
FOUR PERSONAL REFERENCES ARE REQUIRED in addition to your current veterinarian. Only one of these references may be a family member. All references must be 21 years of age or older. NOTE: If you do not provide 4 personal references, your application will be rejected.
	REFERENCE 1	REFERENCE 2
Name:
Address:
City:
State/Province:
Zip:
Home Phone:
Work Phone (with permission):
E-Mail:	@	@
Relationship:
Best time(s) to call:
	REFERENCE 3	REFERENCE 4
Name:
Address:
City:
State/Province:
Zip:
Home Phone:
Work Phone (with permission):
E-Mail:	@	@
Relationship:
Best time(s) to call:
Veterinarian Information
If you have had pets in the past, list the information for the vet that cared for them. Also include an additional Veterinary reference if you have used your current Vet for fewer than 4 years. If you do not currently have a vet, provide the information about the vet that you will be using when you adopt a dog.

VET REFERENCE 1
Name of Practice:
Name of Doctor:
Address:
	City	State/Province	Zip Code
	Phone	E-Mail @
	Current Vet Previous Vet Not used yet
If this is a CURRENT vet, list how long you've used this vet and the names of the animals treated:
If this is a PREVIOUS vet, list how long ago you used this vet and the names of the animals treated:

VET REFERENCE 2
Name of Practice:
Name of Doctor:
Address:
	City	State/Province	Zip Code
	Phone	E-Mail @
	Current Vet Previous Vet Not used yet
If this is a CURRENT vet, list how long you've used this vet and the names of the animals treated:
If this is a PREVIOUS vet, list how long ago you used this vet and the names of the animals treated:
Where You Heard About Us
Where did you hear about us?
INTERNET:�	�Search Engine
	�Cairn Terrier Chat or E-Mail List:��
	�PetFinder.com
	�Link from another Rescue site
WORD OF MOUTH:�	�Shelter:��
	�Rescue Business Card from:��
	�Dog Show/Animal Event:��
	�Friend:��
	I am a member of CairnRescueMentoring Yahoo Group (CRM)
	I am a foster home for CPCRN
	I adopted a dog from CPCRN:
	eBay Auction Site
	Information from Animal Educational Exhibit
	Referral from another Rescue Organization: Rescue Name(s)
	Referral from Cairn Terrier Breeder or Club:
	�Other:�
Agreement

Do you agree to keep the dog licensed and have identification with your name and phone number on the dog at all times?			�Yes ��No
Do you agree to comply with ALL applicable City/Town, County, State and Federal laws as they relate or pertain to the care, treatment and responsibility of dog ownership?			�Yes ��No
Do you agree to contact Cairn Rescue if you can no longer keep this dog?			�Yes ��No
Are you willing to provide a crate for your rescue Cairn to help during the transition period?			�Yes ��No
Do you agree to allow a rescue representative to visit your home by appointment to do a "safety" inspection?			�Yes ��No
If NO, state your reason for declining:
Are you able and willing to make a Rescue Adoption donation if you adopt a Cairn or Cairn mix through rescue?			�Yes ��No
Today's Date:
PLEASE NOTE: At the time you adopt one of our rescue Cairns, you will be asked to make a donation to CPCRN. This donation helps defray shelter fees and other costs paid to procure our Rescues, the cost of transporting them to our foster homes, the costs of providing them with food and appropriate veterinary care, including spay/neuter, immunizations, heartworm testing and prevention, and other medical and/or grooming needs as are required by the particular dogs in our program. The requested adoption donation for young Cairns between the ages of 1 and 6 years is typically between $300.00 and $350.00, depending upon their age; for Cairns 6 years and over, it is typically $200.00. For Cairns in their golden years or which have long-term health issues, the requested adoption donation is usually reduced based on the age of the Cairn and/or the care and medications that the Cairn will require post-adoption. For young puppies under the age of 12 months, the requested adoption donation is typically $375.00, and if the puppy is not altered prior to placement (which would typically be the case if the puppy is under 6 months), we also require that the adopting family agree to a spay/neuter deposit. This deposit is FULLY refundable upon presentation and verification of a spay/neuter certificate. This is further explained in the rescue protocol for young puppies, which you will receive if you are applying for a pup under six months of age. Please verify the requested donation amount on any dog that you are considering for adoption. As adoption donations do not constitute purchase monies paid for the Rescue, they are not refundable in the event that you decide to return the Rescue or for any other reason. By submitting this application, you give us your permission to call all of 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 stating that they may receive telephone calls at their place of employment. Your signature(s) will be required on a formal Adoption Contract prior to adopting any rescue dog. You must also provide proof of being of legal age in your state to sign contracts. Photographic identification with your current address may be required prior to adoption. I understand that CPCRN may, at its sole discretion, determine that a Cairn rescue will not be approved for adoption by me or my family. Please make sure the application is complete and you have entered your e-mail address before pressing the "Submit" button below. Incomplete applications may be rejected or delayed. PLEASE NOTE: Adopting one of CPCRN's rescue Cairns is a multi-step process. Please see our Frequently Asked Questions for details on how the adoption process works. I represent that the information that I have provided on this form is the truth to the best of my knowledge and belief. I/we hereby give my/our permission to CPCRN to use any of the above information to confirm that this rescue application is deemed to be correct. I hereby certify that I have not been convicted or otherwise been found guilty by any governmental authority of animal cruelty, neglect or abandonment, or of failing to provide adequate shelter to an animal.