NCWFA Online Rescue Application

Northern California Whippet Fanciers Association

Whippet Rescue

Please try to fill out this application as completely as possible. Allow at least 30 minutes to complete it. Thank you for your interest!
^* denotes a required field.

Name^*
Address Line 1^*
Address Line 2
City^*
State^*
Zip Code^*
Home Telephone^*
Work Telephone
Email address
Fax number or other contact information

Status	Married Single Living Together Living with Parents
Age(s)
Do you (both) work outside the home?	Yes No
What are your work hours? (list each)
Occupation(s)
Length of Employment (years)
If living with other adults, do they approve of this dog?	Yes No N/A
If living with parents, who will be the actual owner of this dog?	Self Parents N/A
Number of children at home or that visit frequently?
Ages of Children?

Do you rent or own?	Rent Own
House, apartment, condo, other?
Landlord's name
Landlord's phone number
Does landlord allow pets?	Yes No With Restrictions N/A
How long at present address (years)?
Are you planning on moving in the next 6 months?	Yes No
If you move, what will you do with your pets?

Do you have a yard?	Yes No
Approximate size of yard
Do you have a fence?	Yes No
Type of fence
Approximate fence height (at lowest point)
Have you inspected your fence for holes that your dog may try to crawl out of or dig through?	Yes No
Do you have secure latches?	Yes No
Can children open gates?	Yes No
Have you checked your yard for poisonous plants or other items your dog may ingest?	Yes No
Is there anything near the fence that would allow the dog to jump over the fence?	Yes No

Have you ever owned a Whippet?

Yes
No

If so, when?

What happened to the whippet?

Have you ever taken a pet to a shelter?

Yes
No

If so, why?

List all pets currently at home. Include small caged pets and barnyard animals.

Sex	Spayed/Neutered	Kept In or Out
M F	Yes No	In Out
M F	Yes No	In Out
M F	Yes No	In Out
M F	Yes No	In Out

List all dogs owned in the past 10 years:

Breed or Mix	Spayed/Neutered	In or Out	How long owned	What happened to dog?
	Yes No	In Out
	Yes No	In Out
	Yes No	In Out
	Yes No	In Out

Will you enroll your Whippet in an obedience class?	Yes No
What is your main reason for wanting a Whippet?
What functions do you expect? (check all that apply)	Watchdog Hunter Breeder House Pet Companion Companion for other pets For the children Gift
If the dog is a gift, who is it for?

Temperament preferred
(check all that apply)

Very active
Active
Easygoing
Lapdog
Sedate

Intelligent
Playful
Protective
Affectionate
Shy
Independent
Other

I would like my new dog
to get along with:

Other dogs
Cats
Birds
Farm Animals
Young Children

Do all members of the family favor this type of dog?

Yes
No

Does any member of the household have pet allergies?

Yes
No

Sex Preference

M
F
None

Will you consider a dog of the opposite sex?

Yes
No

Age Preference

1^st choice
2^nd choice

The oldest dog I would consider should be no older than years.

Are you financially able to care for this dog should it become seriously ill or require surgery?	Yes No
What arrangements will you make when you go on vacation?
How many hours a day will the dog be left alone?
Where will the dog stay during the day?
Where will the dog be kept at night?
How do you plan to exercise the dog?
Have you ever crate trained a dog?	Yes No
Do you have objections to using a crate for your dog's safety?	Yes No

Who is your vet? Please provide name, number, and address as a reference.

Vet's Name

Vet's Phone Number

Vet's Address

Do you agree to return the dog only to Whippet Rescue, if you find yourself unable to keep it?

Yes
No

Would you be willing to have a club representative visit your home?

Yes
No

How did you find out about us?

Please give 2 personal references:

Name	Phone	Years known	Relationship

Below please list any additional information you may wish us to consider in placing a Whippet in your care:

I hereby certify all the above information to be true and accurate to the best of my abilities.