Adoption Applications AireCanada Application Form Step 1 of 13 7% Applicant Name* First Last Co-Applicant Name First Last Email Address* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Are you willing to have a member of Rescue visit your home by appointment both before and after adoption?* Yes Type of Residence* House Condo Apartment Ranch or Farm Do you Own or Rent?* Own Rent Do you have written permission from your landlord? Yes No Landlord Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Landlord 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?* Yes No Why do you want an Airedale Terrier?*Do all family members want an Airedale Terrier?* Yes No Explain*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?* Yes No What do you know about about Airedales? Include titles of books read and describe other sources of information.Aware of grooming needs?* Yes No Anyone allergic to dogs?* Yes No 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?* Yes No If so, please specify:* Do you prefer:* Male Female No Preference Would you consider the opposite sex if one is more readily available? Yes No What will your Airedale need to get along with? (Check as many as are applicable) Dogs Cats Indoor Birds Small Rodents Poultry Livestock Children Women Men Other Describe How many hours will the dog be alone on an average day? (number 0-24)*Please enter a number from 0 to 24.Where will the dog stay during the day when alone?* N/A Loose in the house Crated in the house Loose in the yard In an outdoor kennel run Where will the dog stay at night?* Do you have a yard?* Yes No Is your yard fenced?* Yes No What are the approximate dimensions of your yard?*Do you have an area in your yard the dog can use as a "digging pit?"* Yes No Is the fenced yard directly attached to the house?* Yes No How tall is your fence?* What activities will you share with your dog? Walking Hiking Obedience Classes Agility Flyball Fishing Hunting Swimming Herding Frisbee Playing Fetch Other (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?* Yes No Are you familiar with crate training? Yes No Do you own a dog crate? Yes No If 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 home Board at Kennel Board with Vet Board with Groomer Dog will go along Other If other explain: List all animals currently in your household :*(type, age, sex, neutered/spayed)Do any of your current animals have medical conditions?* Yes No DescribeAre your current dogs up to date on all shots?* Yes No What brand of heartworm preventative are you presently using?* You would consider giving up your dog if*Have you ever given up a dog?* Yes No explainIf you were unable to care for your pets (death, immobilizing disability), what arrangements have you made?*How many dogs do you currently have* 0 1 2 3 4+ Has your dog ever lived with another large dog? Yes No how 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?* Yes No Were there any Airedales available for adoption through your local Rescue?* Yes No Name of Regional Club Rescue or Individual Rescue Volunteer you contacted Have you ever adopted a dog through Airedale Rescue before? * Yes No Name 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? * Yes Do you understand that if at any time an adopter cannot keep the animal, it must be returned to Airedale Rescue?* Yes Are 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.?* Yes PhoneThis field is for validation purposes and should be left unchanged. Δ