Wayside Rescue and Sanctuary Adoption Application
Companion Dog
www.waysiderescueandsanctuary.org
WSRS Adoption Application
Thayne, Wyoming
This Adoption Application form may be
1) Presented in person to a Wayside Rescue person;
2) E-mailed to linda@waysiderescueandsanctuary.org
3) Snail Mail to: Linda Thielepape, P. O. Box 1050, Thayne, Wyoming 83127
Thank you for your interest in adopting a Dog _____________________ rescued by Wayside
Rescue and Sanctuary (WSRS). We realize the questions in this application sound intrusive at
times, but we want to make sure that the Dog adopted through Wayside Rescue goes to loving,
responsible and committed pet folks! Adopting a rescued dog is a commitment you are making
for the life of this companion animal. It has already lost what s/he thought was his/her Forever
Home; so at WSRS, we want to do everything in our power to help ensure that never happens
again.
Hopefully, you will not find the questions too intrusive. We want to be thorough because we
want to have every opportunity to pair you with a rescued Dog that will meet your expectations,
as well as meet the needs of your new family member.
Three references will be required, as will a veterinarian reference and a house-check (see below
for why).
We do require that all family members be present for the adoption, be it at an Adoption Event, a
Trip to the Wayside Sanctuary in Thayne, Wyoming, or during the Home Visit in order to meet
your new family member. We also recommend that four-legged family members also be present.
Wayside Rescue and Sanctuary
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WSRS Adoption Application
Name(s):
________________________________________________________
Physical Address:
________________________________________________________
Mailing Address:
________________________________________________________
Primary Phone #:
__________________
E-Mail:
___________________________
Secondary Phone #:
_________________
______________________________________________________________________________
About the Dog you want to adopt . . .
1) Is there a particular Dog that you are interested in? If so, please note.
________________________________. You will notice that on occasion we have pairs of dogs
that we do not want separated; so, it would mean adopting both.
2) What size of Dog are you looking for, if size matters? ________________________
3) Neutered Male
Neutered Female
Both
It Doesn’t Matter
4) What age range are you thinking about? _______________________
5) What activity level are you looking for in a Dog? __________________________________
Some Breeds aren’t going to jog with you anywhere, nor will they play Frisbee with you!
6) Briefly, What are you looking for in this companion animal—what would his/her life look
like with you, or you and your family?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
7) In-home companion(s)?
Yes
No
The Dogs that we adopt out are to be companion animals—not relegated to the backyard. They
are also NOT Livestock Guardian Dogs. Actually, many are failed-LGDs preferring the company
of people to sheep and goats!
Wayside Rescue and Sanctuary
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WSRS Adoption Application
About you and your family . . .
1) Will you be adopting this companion animal individually, or will it be being adopted into a
family of more than one?
__________________________________________________________________________
2) If in to a home with two or more people, is there complete family buy-in?
__________________________________________________________________________
3) What is your occupation? ___________________________
The occupation of your spouse/domestic partner? ______________________
4) How many hours a day will the Dog be home alone—without a human to let him/her out for
bathroom breaks and without supervision? _________________________
5) If gone too long for a dog’s bathroom needs, is there someone who will be able to let him/her
out during reasonable & healthy intervals? Or, will you be able to come home mid-day for
bathroom breaks?
Yes No
6) Where will the Dog sleep? ____________________________________________________
7) Do you have an enclosed yard? Yes
No
8) How high is your fence? _______________ What kind of fence is it? Some Dogs like to
wander so your fence MUST BE the type and quality that will keep a Dog retained during their
time outside. Gates must be able to be secured!
______________________________________________________________________________
______________________________________________________________________________
Is the gate normally kept locked?
Yes
No
9) Where will the Dog stay when you/family are/is out of town or on vacation?
______________________________________________________________________________
______________________________________________________________________________
Wayside Rescue and Sanctuary
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WSRS Adoption Application
10) Do you live in an apartment, town home or condominium?
Yes
No
11) If renting, please provide—Landlord’s Name ________________________________
Landlord’s Phone Number ______________________________
12) Do you live in a house? Yes
No
13) If renting, please provide—Landlord’s Name ________________________________
Landlord’s Phone Number ______________________________
14) How long have you lived at this residence? __________________
15) List names and ages of all people living in the home, including yourself.
Name
16) Do you have children visiting?
Wayside Rescue and Sanctuary
Age
Yes
No
If Yes, what ages? _____________
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WSRS Adoption Application
17) If you have pets currently, please list them below.
Type of Animal
If a Dog: Breed
Name
Age
Sex
M F
Spayed/
Neutered?
Indoor/
Outdoor?
18) If you have a cat(s), has your cat lived with a dog in your home before?
Yes
No
19) Please list all the animals you have had in the past 5 years that are NOT LISTED ABOVE.
Type of Animal
Age
Sex
M F
Spayed/
Neutered?
Indoor/
Outdoor?
What happened to this
animal?
20) What type of obedience training do you use? ____________________________
Wayside Rescue and Sanctuary
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WSRS Adoption Application
21) What type of arrangements would be made if you were no longer able to take care of your
adopted Dog? If you do not have a loving family member or friend that meets the specifications
you were approved by, it is requested that the animal be returned to WSRS.
______________________________________________________________________________
______________________________________________________________________________
References . . .
1)
Veterinarian:
Phone #
Complete
Address
Years of
Service
2) If you do not currently have a veterinarian, we require that a relationship be established with
one prior to finalizing the adoption.
3) Personal References. Please give us three references. Only one may be a family member.
You will want to let them know you have given WSRS their name and number so that they do
not think our Applications Processing Volunteer is a solicitor:
Name
Relationship
Yrs.
Phone #
City/State
Known
Wayside Rescue and Sanctuary
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Wayside Rescue and Sanctuary Adoption Contract--Continued
Adoption Fees: Adoption fees help defray the costs of all rescued animals—Food, Heartworm
Testing and Prevention, Flea and Tick Prevention, Spaying/Neutering, Vaccinations,
Microchipping, Worming, and any other medical expenses that may be necessary—i.e., arthritis
medication for the older animals, eye ointment and salves, antibiotics for those who come with
wounds or upper respiratory infections, Heartworm Treatment for HW+ dogs, et al.
According to the estimated* age of this dog, his/her adoption fee is $__________.
$200 Great Pyrenees Up To 5 Years Old*
$150 Great Pyrenees (5+ to 8 Years Old)*
$100 Great Pyrenees (8+ Years Old)*
$75 Non-Pyr
*as ascertained by examining veterinarian
Each Wayside Rescue and Sanctuary Dog will have received the following if age permits:
Spayed/Neutered
Vaccinated against Rabies (certificate provided)
9-Way Vaccination--a combination of immunogenic, attenuated strains of
Canine Distemper, Canine Adenovirus Type 2 (CAV-2), Canine Parainfluenza,
and Canine Parvovirus Type 2b, propagated in cell line tissue cultures.
If required by Veterinarian, Re-Vaccinated with a Booster.
Tested, and if necessary Treated for Heartworms--(HW) Negative
Provided with information regarding monthly HW, Flea and Tick Prevention,
with Brand, Dose and Last Date Given (See Medical Records)
Heartworm Positive Dogs are normally not adopted out until they have finished
treatment through Animal Trustees of Austin—Open to possibilities.
Microchipped
Wayside Rescue and Sanctuary
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