BWTA TERRIER RESCUE

{affiliated with the Bluegrass Working Terrier Association}

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Name Address City / State / ZIP Home / Cell phone number Email address Occupation Own or Rent Your Home?OwnRent If Rent, do you have landlord's permission to have a dog?YesNo Landlord's Phone no.? Do you have a fenced yard or kennel suitable to contain a dog?YesNo If no fence or kennel, how will you handle the terrier's exercise and toilet needs? Do you have a suitable dog crate?YesNo How many hours a day must terrier be alone? Are there children in the household? Ages? Are any members of your household allergic to animals? Would you describe your lifestyle as active or passive? What activities do you plan with this dog? Pet/Agility/Obedience/Other? Do you own other dogs? How many/sex/age? Do you own cats? Other small animals? Describe Have you owned a terrier before?tYesNo Why did you choose this breed? Do you intend to keep this dog primarily Indoors or Outdoors?IndoorsOutside Where will the dog sleep? Do you have a regular veterinarian?YesNo Veterinarian's name/address/phone? Name of dog you are interested in? Would you consider a dog of a different age/sex?YesNo Do you have an age or sex preference? If you found you could not keep this dog, what would you do? Personal reference -name/phone?