Kerry Blue Terrier Adoption Questionnaire

The questions below are meant to help you determine if a Kerry is the right breed for you, and to guide you in thinking about all the ways a dog will impact your life. The questions address various aspects of dog ownership that should be given serious consideration before you decide to share your life with any dog. Your answers help us assess your suitability as a home for a Kerry, and to match a dog to your particular lifestyle. Please be as specific as possible, and answer all questions as completely and truthfully as you can. It helps us help you! Extra blanks are provided for additional comments. When you are finished, please send it to Gail Traughber at gtraughber@gmail.com

You and Your Family

Name ________________________________________________
Address _____________________________________________
_____________________________________________________
Home Phone __________________________________________
Work Phone __________________________________________
Email _______________________________________________

How long have you lived at your current address? ________

If you have a second home, please provide:
Address ______________________________________________
______________________________________________________
Phone ________________________________________________

Please list every person who currently resides at your residence.
Name                       Relation to You           Age
________________________   _______________________   ______
________________________   _______________________   ______
________________________   _______________________   ______
________________________   _______________________   ______
________________________   _______________________   ______

Who will be primarily responsible for the dog's care and training?
________________________________________________________________________

Does anyone in your household have any known allergies to animals?
     Yes   No   If yes, please explain ___________________________
     ___________________________________________________________________

Preferences

Please check any preferences. (Note that the age and pedigree of dogs 
rescued from animal shelters cannot be verified.) 
     Male       Female      No preference 
     Puppy      Adult       No preference 
     Purebred   Kerry mix   No preference 
Any other preferences?_________________________________________________
Are you willing to consider a dog:
     --with special medical or nutritional/dietary needs?  Yes  No
     --who was abused or neglected and needs extra love and attention?  Yes  No
     --with behavior problems that may require special training?  Yes  No
     Comments? ________________________________________________________
How long are you willing to wait for a Kerry? _________________________

Why a Kerry?

How did you first learn about the Kerry Blue Terrier breed?
_______________________________________________________________________
What attracted you to the Kerry Blue Terrier?
_______________________________________________________________________
How would you describe the ideal dog for you and your family? (Please be
as specific as possible.) _____________________________________________
_______________________________________________________________________
What other breeds have you considered? ________________________________
_______________________________________________________________________
Have you and your family discussed the pros and cons of owning a 
Kerry Blue Terrier?
     Yes  No ____________________________________________________
What concerns do you have about the breed? ____________________________
_______________________________________________________________________
Are you familiar with the temperament and characteristics of terriers 
in general and Kerries in particular? Yes   No
     Explain __________________________________________________________
     __________________________________________________________________
Please explain your experience and understanding of the breed.
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Have you previously owned a Kerry Blue Terrier?  Yes  No
     If yes, when did you acquire it? Year ____________________________
     Breeder's name ___________________________________________________
     Location _________________________________________________________
Have you personally met a Kerry Blue Terrier?  Yes  No
     If yes, please describe __________________________________________
     __________________________________________________________________

Pet Ownership

Why do you want a dog? ________________________________________________
_______________________________________________________________________
Do you have any reservations about dog ownership, the commitment, responsibilities, 
the work, and resources required?  Yes  No
     If yes, please describe __________________________________________
     __________________________________________________________________
Have you ever owned a dog before? Yes  No
     If no, have you ever lived in a household with a dog? Yes  No   
     How long ago? _________________________
What dog care responsibilities did you have? __________________________
_______________________________________________________________________
Please list all the animals that currently live in your household.
Type/Breed       Sex    Altered?     Age   Years   Where do you keep
                                           owned        the dog?
______________   ___  Yes No  ____   ____   ____________________
______________   ___  Yes No  ____   ____   ____________________
______________   ___  Yes No  ____   ____   ____________________
______________   ___  Yes No  ____   ____   ____________________
______________   ___  Yes No  ____   ____   ____________________
Please list any dog you have owned in the past and explain what happened to it.
Breed            Sex    Altered?    Age    Years     Dates        What happened to 
                                           owned     owned           this dog?
______________   ___  Yes No  ____   ____   ____to_____   ___________________
______________   ___  Yes No  ____   ____   ____to_____   ___________________
______________   ___  Yes No  ____   ____   ____to_____   ___________________
______________   ___  Yes No  ____   ____   ____to_____   ___________________
______________   ___  Yes No  ____   ____   ____to_____   ___________________
Of the dogs that you own or have owned, what do you enjoy most about dog ownership? 
_______________________________________________________________________
_______________________________________________________________________
What do you like least about dog ownership? ___________________________
_______________________________________________________________________
_______________________________________________________________________
Have you ever trained one or more dogs? Yes  No
Have any of your dogs had puppies or fathered a litter? Yes  No
     If yes, please describe __________________________________________
     __________________________________________________________________
Have you ever owned a "problem" dog? Yes  No
     If yes, please describe __________________________________________
     __________________________________________________________________
What experience, if any, have you had with dog aggression?
_______________________________________________________________________
Have you ever had any complaints from others about your pets?  Yes  No
     If yes, please describe __________________________________________
     __________________________________________________________________
Based on your past dog experience, is there anything you might do differently with 
your next dog? Yes  No
     If yes, please describe __________________________________________
     __________________________________________________________________
How will you safely introduce and integrate a Kerry with your existing pets?
_______________________________________________________________________
_______________________________________________________________________

Your Home

Which of the following best describes your current residence? 
    Own a single family home 
    Rent/Lease a single family home 
    Own a townhouse/condo 
    Rent/lease a townhouse/condo/apartment
    Other _________________________________________________________
If you rent/lease, is your landlord agreeable to your owning a dog?  Yes  No
Does your lease or home owners association have any covenants or restrictions on pet 
ownership? (A copy of the lease will be requested before an adoption is finalized.) 
    Yes  No  __________________________________________________
Does your town or city have any restrictions on the number of dogs you can have?
    Yes  No  __________________________________________________
Would any of your neighbors object to your getting a dog?  Yes  No

Your Yard

Is your back yard completely and securely fenced?  Yes  No
     If not, please explain how you plan to exercise your dog and allow it to 
     relieve itself? __________________________________________________
Type: ________________________________________ Height: ________________
Is the fence secure and solid?  Yes  No
What type of gates do you have? _______________________________________
Do all the gates have locks?  Yes  No  __________________________
Can children open the gates?  Yes  No  __________________________
Can a dog dig under the fence?   Yes  No  _______________________
If you have a pool, is it fenced?  Yes  No  _____________________
If you have a dog run, is it secure?  Yes  No  __________________
                         Is it shaded?  Yes  No  ________________
Does your yard contain any plants known to be poisonous to dogs? 
Yes  No
     If yes, please list ______________________________________________
     __________________________________________________________________
Does your yard contain any objects or landscaping that the dog could use to climb 
the fence?  Yes  No
     If yes, please describe __________________________________________
     __________________________________________________________________
Are there any dangerous articles in your yard that could harm a dog?  Yes  No
     If yes, please describe __________________________________________
     __________________________________________________________________
What types of improvements are needed to provide a secure yard?
_______________________________________________________________________
Are you willing to make the improvements?  Yes  No  _____________
     If yes, when and how long will they take? ________________________
What distractions are you aware of outside your yard that could plague a dog 
(such as a neighbor's dog or cat, loose dogs on street, mischievous children)? 
_______________________________________________________________________
Do you allow friends, relatives, and children to gain admittance to your home, 
property, and car without your knowledge or supervision?   Yes  No
Can service people or strangers gain access to your yard without your knowledge 
or supervision?   Yes  No

Care & Responsibility

Is someone normally at home most of the day?  Yes  No
How many days will the dog be alone in a normal work week? _________ days
     How many hours per day?  _________ hours
How much time do you have to spend with your Kerry on a normal workday? 
_______________________________________________________________________
     On a normal free day? ____________________________________________
Where will your Kerry spend the day?
    Loose indoors 
    Basement 
    Crate 
    Garage 
    Kennel run 
    Loose outdoors in fenced yard
    Tied up outside
    Other __________________________________________________________
Will there be some protection from the elements when outside?  Yes  No
Where will the dog sleep at night? (Please be specific.) ______________
_______________________________________________________________________
What routine family activities will your dog participate in?
_______________________________________________________________________
_______________________________________________________________________
How regularly (daily, weekly, or monthly) and for how long (miles or minutes) 
will the dog be exercised? ____________________________________________
_______________________________________________________________________
Who will be responsible for exercising the dog? _______________________
Do you travel frequently?  Yes  No  _____________________________
Who will take care of your dog while you are away? ____________________
_______________________________________________________________________
Will your dog be professionally groomed?  Yes  No
  If yes:
     Groomer's Name ___________________________________________________
     Grooming Shop ____________________________________________________
     Location _________________________________________________________
     Work Phone _______________________________________________________
  If not, who will groom the dog? _____________________________________
Approximately how often will the dog be groomed?
     Bathing _____________________________________________
     Brushing/comb out ___________________________________
     Trimming ____________________________________________
Do you have the time, and are you physically able, financially prepared, and 
willing to:
   --Pay someone up to $65 or more to groom your Kerry?
     Yes  No  __________________________________________________
   --Purchase a grooming table, clippers, scissors, and other accessories ($250-$300 
     investment) and devote the time to learn to groom your Kerry yourself?
     Yes  No  __________________________________________________
   --Spend approximately one hour each week brushing and combing out your Kerry, 
     or more if it gets into foxtails, burrs, or gets wet?
     Yes  No  __________________________________________________
   --Pluck the hair growing inside the Kerry's ear canals every month to prevent 
     ear infections?
     Yes  No  __________________________________________________
   --Clean the eyes of accumulated matter every single day if necessary?
     Yes  No  __________________________________________________
   --Pay for the cost of both routine veterinarian care (worming, annual shots)  
     and non routine/emergency veterinary care, especially as the dog gets older?
     Yes  No  __________________________________________________
Do you have a veterinarian you have used before and plan to use with your next dog? 
Yes  No   If yes:
     Veterinarian's Name ______________________________________________
     Clinic ___________________________________________________________
     Location _________________________________________________________
     Work Phone _______________________________________________________

Behavior and Training

Would you be willing to participate in a formal obedience training program with 
your Kerry?  Yes  No  _________________________________________
Have you ever trained one or more dogs?  Yes  No  If yes:
     Type of training _________________________________________________
     When _____________________________________________________________
     Where ____________________________________________________________
     Method ___________________________________________________________
     Instructor _______________________________________________________
Are you familiar with crate training and its dos and don'ts? 
    Yes  No  ____________________________________________________
Are you willing to provide training to resolve behavior problems?
    Yes  No  ____________________________________________________
What kind of good behavior do you expect of this dog? _________________
_______________________________________________________________________
_______________________________________________________________________
How would you discipline your dog if he made a mistake? _______________
_______________________________________________________________________
What amount of time and effort do you want to devote to training your dog?
_______________________________________________________________________
How would you describe your attitude about training (firm, tolerant, lenient, etc.)?
_______________________________________________________________________
Have you done any reading on animal behavior modification/dog training?
    Yes  No  If yes, please list the books you have read ________
     __________________________________________________________________

Commitment

A Kerry Blue Terrier can live to be 15 years, representing a 15-year commitment to 
you. Consider how old you will be 15 years from now, and how you will feel about this 
commitment then. 

Are you and those living with you committed to spending the next 15 years 
providing health care, food, grooming, training, and attention to your Kerry?
    Yes  No  ____________________________________________________
Is there a chance that you might move at least once in the next 15 years?
    Yes  No  ____________________________________________________
Are you willing to take your Kerry with you, and restrict your choice of housing 
to places where pets are allowed?
    Yes  No  ____________________________________________________
Have you carefully considered how the dog will fit into your current lifestyle, 
and how dog ownership will change your daily routine and schedule?
    Yes  No  ____________________________________________________
What changes do you expect in your lifestyle and daily routine when you own a dog?
_______________________________________________________________________
_______________________________________________________________________
Is there a possibility that your current lifestyle is so busy you might not have 
the time or energy to properly care for a Kerry Blue Terrier? Yes  No
     Explain __________________________________________________________
Think about what major changes might happen in your life in the next 15 years. 
     Marriage? Yes  No  _________________________________________
     Divorce? Yes  No  __________________________________________
     Children? Yes  No  _________________________________________
     Job uncertainty? Yes  No  __________________________________
     Job transfer? Yes  No  _____________________________________
     New career? Yes  No  _______________________________________
     Retirement? Yes  No  _______________________________________
Are you willing to continue spending the time, energy, and money to care for the 
Kerry as you deal with these life changes or new responsibilities?
    Yes  No  ____________________________________________________
What will you do if your spouse or children can't get along with the Kerry? 
_______________________________________________________________________
If you're getting a pet for children you have now, how old will they be in 15 years? 
_______________________________________________________________________
Are you willing to teach young or inexperienced children how to respect and 
properly handle a live animal?
    Yes  No  ____________________________________________________
Are you willing to accept that the dog may not like all your children's friends?
    Yes  No  ____________________________________________________
Will you still want the Kerry after the kids have grown up and moved out?
    Yes  No  ____________________________________________________
Have you previously owned a pet that didn't live with you for 10 years or more? 
    Yes  No  ____________________________________________________
     If yes, what happened to it? _____________________________________
     __________________________________________________________________
What will you do differently with this pet to prevent it from going the way your 
previous pet did? _____________________________________________________
_______________________________________________________________________
Does everyone in the family want a dog? Yes  No
     What members are enthusiastic? ___________________________________
     Unenthusiastic? __________________________________________________
What complaints or concerns have been raised? _________________________
_______________________________________________________________________

References

Please provide three names as references, including your landlord (if you rent your home), and your veterinarian, groomer, or dog trainer (if you have one). If you belong to a dog club or any dog-related group, include the name of an officer or associate. Other references could include a neighbor, your employer, a friend, or relative who owns a Kerry, another terrier, or another high maintenance breed (such as a poodle or Afghan Hound).

Name                       Phone Number          Relationship to applicant
_________________________  ____________________  ______________________
_________________________  ____________________  ______________________
_________________________  ____________________  ______________________
_________________________  ____________________  ______________________

Placement Information

Thank you for taking the time to complete this questionnaire. We appreciate people who are willing to consider adopting a Kerry Blue Terrier. Your answers will permit us to more effectively match available dogs' needs with your lifestyle and requirements. To help expedite the process, your Adoption Questionnaire may be shared with other Kerry Rescue Coordinators or Kerry breeders with dogs to place. If you have any comments or concerns about adopting a Kerry Blue Terrier or about our Rescue program, please feel free to share them with us.

This Kerry Blue Terrier Club is a not-for-profit organization working to ensure the continued welfare of our breed by rehabilitating and placing Kerries and Kerry mixes from various situations, including rescues from shelters. We do not charge for placing Rescue Kerries in new homes. However, to continue our rescue work, we ask for a donation to our Rescue Fund if we are successful in matching you with a Kerry. You may also need to assume any shipping charges and related expenses regarding the delivery of the dog to you.

In addition, you will be asked to sign an Adoption Contract which requires, among other things, that the dog be returned to the club immediately should you no longer be able to keep it. It may not be sold, transferred, or given to any individual or establishment. In the unlikely event that the dog is unaltered, you will be required to have it spayed or neutered within 90 days of adoption. Under no circumstances should the dog be bred. You will also be required to take the dog to a veterinarian within 3 days of the date of the Adoption Contact for a check up and any necessary medical treatment.

The club makes no representation as to the physical condition, temperament, habits, personality features, or other aspects of the dogs available for adoption. The club is in no way liable or responsible for any damage, accident, or injury resulting from the adoption of any dog or the future conduct of that dog.

All of the information I have provided in the questionnaire is true and complete to the best of my knowledge. I understand that any deliberately false, misleading, or omitted information that may affect a placement decision is grounds for removal of a dog from your possession. Should a Kerry be placed with me, it will reside in my home as a pet. I agree to provide the dog with adequate food, water, shelter, affection, and medical care, and to fulfill the conditions of the Adoption Contract.

Signature of Applicant ___________________________________________________

Signature of Applicant ___________________________________________________

Date of Application ______________________________________________________

Home phone ______________________ Work phone _____________________________

Email ____________________________________________________________________