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Wheatens In NeedŽ Adoption Application
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Please Complete All Fields
First Name:
Last Name:
Address:
City:
State/Province:
Zip/Postal Code:
Email:
Home Phone:
Work Phone:
Cell Phone:
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Why do you want to adopt a Soft Coated Wheaten Terrier?
Have you previously owned a Wheaten? YesNo
What other breed(s) of dog have you owned?
What happened to your last dog?
Do you have other dogs or cats? YesNo
If yes, specify breed, sex and age of all dogs and cats in the home.
Are other dogs in the home spayed/neutered? YesNo
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How many adults in the household?
How many children?
Please state ages of children:
Are all family members "on board" with getting a Wheaten? YesNo
Who will be the primary care giver for the Wheaten?
Is someone home during the day? YesNo
What is the longest time the dog would be left alone?
Where will the dog spend the day or be kept when you are gone from home?  (Loose indoors, loose outdoors, crated, kennel run, tied out, other-specify)
Do you have a fenced yard? YesNo
What kind of fence?
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Do you own your home or lease? OwnLease
If you rent, do you have your landlord's permission to have a dog? YesNo
Do you primarily intend to keep your Wheaten outdoors or indoors? OutdoorsIndoors
Are you aware of the grooming needs of a Wheaten? YesNo
Will you obedience train the dog? YesNo
Are you willing to adopt a dog that needs additional training? YesNo
Will you accept a dog needing special medical attention? YesNo
Since Wheatens normally remain spirited and active well into the double digits of their lives, are you willing to adopt an older dog? YesNo
Do you have a preference as to Male or Female? MaleFemaleNo Preference
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Do you have a current veterinarian? YesNo
Veterinarian Name:
Address:
City:
State/Province:
Zip/Postal Code:
Telephone number:
How did you learn about Wheatens In Need?
Additional information you would like to give us:
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To what states are you be willing to travel to obtain a Wheaten?

Select one or more regions below
or individual states on the right.

All States
Northwest (AK,ID,OR,WA)
West (CA,HI,NV,UT)
Rocky Mountain (CO,MT,WY)
Upper Midwest (MI,MN,ND,SD,WI)
Midwest (IA,IL,IN,KS,MO,NE,OH)
Southeast (AL,AR,FL,GA,KY,LA,MS,NC,SC,TN)
Southwest (AZ,NM,OK,TX)
Northeast (CT,MA,ME,NH,NJ,NY,RI,PA,VT)
MidAtlantic (DC,DE,MD,WV,VA)

Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky		 Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota		 Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington, DC
West Virginia
Wisconsin
Wyoming
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I hereby certify that all the information contained on this application is true and correct. I certify that my purpose in adopting a Soft Coated Wheaten Terrier is to have a family pet and not to use for research. I understand that I will be required to sign a Conditions of Adoption Agreement and a Placement Agreement. This application will become part of those agreements, and any misrepresentation in this agreement will constitute a breach of the Conditions of Adoption and the Placement Agreement.

The adoption fees are as follows:

$425 -- 1 year and under
$400 -- 1 year and under 2 years
$375 -- 2 years and under 3 years
$350 -- 3 years and under 4 years
$325 -- 4 years and under 5 years
$300 -- 5 years and under 7 years
$275 -- 7 years and older
The adoption fee is due on receipt of the Placement Agreement and the Conditions of Adoption
Wheatens In Need is a 501c-3 non-profit organization and is funded entirely though private donations and adoption fees.
By signing this application, I agree to pay the adoption fee appropriate for the Wheaten that I adopt.
Signature (type your complete name)
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Our Adoption Applications are filed by State.  Please mention your State when inquiring about your application.  Should you get another dog and are no longer interested in adopting from WIN, please let us know so we can delete your application from our files.
Without the help of hard working volunteers, WIN would not be able to rescue and re-home Wheatens.  There are many ways to help.  We need experienced, (dog knowledgeable) People to foster, we also need volunteers to help WURL (transport our dogs), and of course we need financial support.  Take a look at our Volunteer Information and let us know if, after you have gotten your Wheaten, you would be willing to become a WIN volunteer.

Donald E. & Gwen B. Arthur
417 River Bend Dr.
Blanco, Texas 78606
(h) 830-833-0435 (c) 713-906-6048
ledition@earthlink.net