If you are interested in adopting a Rescue Cairn, please fill out the following form. The information you provide will help us find the best fit. All information provided here will remain confidential.

Please Note: This application is for residents of Virginia, West Virginia, Delaware, Maryland, and Washington D.C. ONLY. If you live outside of this area, you can find information on Cairn Terrier Rescue volunteers in your area at www.cairnterrier.org.

Your application will remain on file for two months. If you are still interested in adopting a Cairn after that time, you must submit another application.

This form works best with Chrome, Firefox, or Internet Explorer (no Safari). If you are still having problems submitting this application, please contact the webmaster with details about the issue.

*Required fields
* Name:
*Address:
*City:	Select One Delaware District of Columbia Maryland Pennsylvania Virginia West Virginia	NOTE: This application is for residents of Virginia, West Virginia, Delaware, Maryland, Washington D.C., and Pennsylvania ONLY. You can find Cairn Terrier Rescue volunteers in your area at www.cairnterrier.org/rescue/.
*State:
*Zip Code:
*Phone:
*E-mail:
*Your Age:	Select Under 21 21 - 24 25 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 Over 79
1. Have you ever owned a Cairn Terrier?   Yes   No
If Yes, for how long?
Why do you want a Cairn Terrier?
2. Do you have young children living with you?   Yes   No
If Yes, how many?
What are their ages?
What experience have your children  had with caring for a dog?
PLEASE NOTE: Because the history of a Rescue dog is unknown, PCTC will NOT adopt to families with children aged 7 years and under. 3. Do you have young children that come and visit with you (i.e. grandchild, niece/nephew, etc.)?   Yes   No
If Yes, what are their ages?
What experiences have these  children had with dogs?
4. Do you currently have a dog?   Yes   No
If Yes, what breed(s)?
What age(s)/gender(s)?
	Spayed/Neutered?   Yes   No
5. Have you ever owned dogs previously?   Yes   No
If Yes, what breed(s)?
What became of it/them?
6. Do you have other pets?   Yes   No
If Yes, what kind?
7. If you currently have dog(s), do you have a plan for integrating a new dog into your home?   Yes   No
If Yes, please describe your plan:
8. Do you currently have a local veterinarian?   Yes   No     If Yes, may we contact him/her?   Yes   No
Vet Name:
	City	State
Phone:
9. In what type of home do you live?  Select One Single Family Townhome Condominium Apartment Cabin Motorhome Boat Do you rent or own your home?   Rent   Own     If you rent, will your landlord allow pets?   Yes   No Do you have a fenced yard?   Yes   No
If Yes, describe height and materials:
PLEASE NOTE: PCTC will NOT adopt Rescue Cairns to homes where invisible fencing is the primary means of keeping the dog in the yard when outdoors.     If no fence, would you be willing to fence in a portion of your yard?   Yes   No
If No, why not?
When you are NOT in a securely fenced area, will you agree to ONLY walk and exercise the dog on a leash?   Yes   No Are you willing to have a rescue volunteer visit your home?   Yes   No 10. Who will be responsible for caring for the dog?
	Myself   My Spouse   My Child   Other
11. Do you agree to provide all necessary veterinary care for the dog, including annual booster vaccines, heartworm testing, heartworm preventative, and general health care?   Yes   No 12. Will anyone be home during the day?   Yes   No
If Yes, who?
How may hours will the dog be alone during the day?  Select One 1 - 2 Hours 3 - 6 Hours 7 - 9 Hours More than 9 Hours 13. Where will the dog be kept when you are NOT at home (be specific)?        Where will the dog be kept when you ARE at home (be specific)?        Where will the dog be kept at night (be specific)?  14. We require that all dogs adopted from us be spayed or neutered.       Do you have any questions or reservations about this policy?   Yes   No
If Yes, please explain:
15. Who will care for the dog when you go on vacation?  Select One Friend Relative Dog Sitting Service Board at Vet Board at Kennel
If you move, what will you do with this dog?
16. Cairns can live well into their teens. Are you willing to take responsibility for this dog for the next 10 or more years?   Yes   No In case you can no longer care for the Cairn, what provisions would you make in your will for its continued care?  (i.e., Do you have a specific person to designate for the Cairn's future care? )
17. Have you considered how much it will cost to care for this dog each year?  (include veterinary care, food, grooming, licensing)  Yes   No 18. What gender Cairn do you prefer?  No Preference Male Female
What age?	No Preference
	Between the ages of 0 1 2 3 4 5 6 7 8 9 10 years and 1 2 3 4 5 6 7 8 9 10 11 12 years old
Additional Comments:
Your application will remain on file for two months. If you are still interested in adopting a Cairn after that time, you must submit another application. Please make sure the application is complete before pressing the "Submit" button below. Incomplete applications may be rejected or delayed.