Adoption Applications AireCanada Application Form Step 1 of 13 7% Applicant Name*FirstLastCo-Applicant NameFirstLastEmail Address*Address*Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweCountryPhone*Are you willing to have a member of Rescue visit your home by appointment both before and after adoption?*Yes Type of Residence*HouseCondoApartmentRanch or FarmDo you Own or Rent?*OwnRentDo you have written permission from your landlord?YesNoLandlord AddressStreet AddressAddress Line 2CityState / Province / RegionZip / Postal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweCountryLandlord Phone Family Information*Please list family members who live with you along with their ages.Visitors*Please list family members and friends who visit regularly, but do not live with you, along with their ages.Do you plan to add to your family in the next five years?*YesNoWhy do you want an Airedale Terrier?*Do all family members want an Airedale Terrier?*YesNoExplain*If No, Explain who does not and why. Describe your family's typical day and how your dog(s) fit into that day. (or how you anticipate your new dog fitting in if you don't currently have a dog).Is this your first Airedale?*YesNoWhat do you know about about Airedales? Include titles of books read and describe other sources of information.Aware of grooming needs?*YesNoAnyone allergic to dogs?*YesNo How do you feel about muddy footprints on carpet & bedspreads?*Describe the kind of temperament you are looking for in a dog.*(i.e., calm, energetic, aloof, affectionate, etc.)What qualities appeal to you about the Airedale?*Who will be the primary person responsible for the Airedale Terrier?*Daily work hours of primary caretaker.*Do you have any experience with obedience training?*YesNoIf so, please specify:* Do you prefer:*MaleFemaleNo PreferenceWould you consider the opposite sex if one is more readily available?YesNoWhat will your Airedale need to get along with? (Check as many as are applicable)DogsCatsIndoor BirdsSmall RodentsPoultryLivestockChildrenWomenMenOtherDescribe How many hours will the dog be alone on an average day? (number 0-24)*Please enter a value between 0 and 24.Where will the dog stay during the day when alone?*N/ALoose in the houseCrated in the houseLoose in the yardIn an outdoor kennel runWhere will the dog stay at night?*Do you have a yard?*YesNoIs your yard fenced?*YesNoWhat are the approximate dimensions of your yard?*Do you have an area in your yard the dog can use as a "digging pit?"*YesNoIs the fenced yard directly attached to the house?*YesNoHow tall is your fence?* What activities will you share with your dog? WalkingHikingObedience ClassesAgilityFlyballFishingHuntingSwimmingHerding Frisbee Playing FetchOther(Check as many as are applicable)If other describe:What will you do if the dog chews one of your shoes?*What will you do if the dog marks in the house?*Estimate monthly expenses for each dog:*Estimate annual medical costs for each dog:Would you be willing to take a dog with minor health problems?*YesNo Are you familiar with crate training?YesNoDo you own a dog crate?YesNoIf you would use a crate, in what room would you put the crate?*What arrangements will be made for the dog during extended absences?Caretaker will come to homeBoard at KennelBoard with VetBoard with GroomerDog will go alongOther If other explain: List all animals currently in your household :*(type, age, sex, neutered/spayed)Do any of your current animals have medical conditions?*YesNoDescribeAre your current dogs up to date on all shots?*YesNoWhat brand of heartworm preventative are you presently using?* You would consider giving up your dog if*Have you ever given up a dog?*YesNoexplainIf you were unable to care for your pets (death, immobilizing disability), what arrangements have you made?*How many dogs do you currently have*01234+Has your dog ever lived with another large dog?YesNohow long has your current dog been the only dog of the house?* When will you be ready for your new dog?*Dog Groomer (Business name/phone number)*List name, address, telephone of your veterinarian*Reference*PLEASE LIST ONE REFERENCE NOT RELATED TO YOU (Name, Address, Telephone) If possible, list a neighbor and someone else familiar with your current or past petsAny other information you wish us to consider in placing one of our Airedales with you? Have you contacted a Rescue Volunteer in your area?*YesNoWere there any Airedales available for adoption through your local Rescue?*YesNoName of Regional Club Rescue or Individual Rescue Volunteer you contactedHave you ever adopted a dog through Airedale Rescue before? *YesNoName of Regional Club Rescue or Individual Rescue Volunteer who provided your previous Airedale.Why do you want an Airedale from RESCUE?*Do you understand that rescues are spayed/neutered or have a spay/neuter contract? *YesDo you understand that if at any time an adopter cannot keep the animal, it must be returned to Airedale Rescue?*YesAre you aware that if Rescue places a dog with you, you will be asked to make a donation, which helps defray costs such as shelter fees, veterinary care, etc.?*YesNameThis field is for validation purposes and should be left unchanged.