Please fill out the form completely. We cannot process incomplete applications or applications without a phone number.

We reserve the right to refuse an applicant.

Personal Information

* indicates required field
* First Name:
Middle Name:
* Last Name:
  Spouse's First Name:
Spouse's Middle Name:
  Spouse's Last Name:
* Home Phone (include area code):
* Work Phone (include area code):
  Cell Phone (include area code):
  Fax Phone (include area code):
* Best time to call:
* E-mail:
* Type email address again:
* Street Address:
* City:
(State is required if you live in USA.)
* Country:
* Zip/Postal Code:
* Your Occupation:


Name of Personal Reference (not a family member, please!):
* Phone (include area code):
Home Information


Do you own or rent your home? Own Rent

  If you rent:
Do you have your landlord's permission to keep a dog? Yes No
  Landlord's Name:
  Landlord's Phone (include area code):


Do you live in a... House Apartment Trailer Other

  If "Other", please describe:


How long have you lived at this address?


Do you have a fenced yard? Yes No


If you don't have a fenced yard, how will you handle the dog's exercise and toilet duties?

  If you have a fenced yard:
Fence height
Fence type Chain Link
  Brick/Cinder Block
  Does fencing completely enclose a yard for the dog? Yes No
* Do you have a separate kennel run? Yes No
  If you have a separate kennel run:
Kennel height
Kennel size
* How many adults in household?
* How many children?
  Age and sex of children (if applicable)
* Are there regular visitors to your home (human or animal) with which your new dog must get along?
Yes No
  If so, please describe
Pet History

* Do you own other dogs? Yes No
  If so, which have been neutered/spayed?
  Give breed, sex, and age of each
* Do you own cats? Yes No
  If so, how many?
* Do you own other animals? Yes No


Name of regular veterinarian
* Phone (include area-code!)
  Vet's Address
* How many dogs have you owned in the last five years?
  List breeds and indicate if you still own the dogs:
  For dogs you no longer own, what happened to them? (be specific)
Adoption Information

* Have you read the Q&A section of the website? Yes No
* Have you read the sample adoption contract on the website and do you agree to the terms and conditions of the contract? Yes No
* Have you owned a Soft Coated Wheaten before? Yes No
* Why do you choose the Soft Coated Wheaten?
* Are you aware of the grooming needs of a Soft Coated Wheaten? Yes No
* Plans for this dog ..... Pet Guard Herding Obedience Other
  If "Other", describe
* Are you interested in adopting a Full Bred Only Mixed Breed No preference
* Where will dog spend the day?


Loose indoors Crate Basement Garage Fenced yard
Kennel run Tied up Outdoors Other  
  If other, describe
* How many hours on the average will the dog spend alone per day?

Where will dog spend the night?

Loose indoors Crate Basement Garage Fenced yard
Kennel run Tied up Outdoors Other  
  If other, describe
* Are you willing to adopt a Wheaten who needs additional obedience training and/or socialization? Yes No
  Please elaborate.


Are you willing to adopt a Wheaten with special medical needs? Yes No


Please elaborate.

* What S'Wheat Rescues Dog(s) are you interested in?
(Please list specific names - app cannot be processed without specific names)
* Do you understand S’Wheat Rescues requires all Dogs to be spayed or neutered prior to any adoption being finalized? Yes No
* Do you agree to license this dog and give regular health care? Yes No
* How far are you willing to travel to adopt a Wheaten?
* Are you aware that S'Wheat Rescues does not ship or transport dogs? Yes No
* Do you agree to physically pick up dog at dog's current location within 2 weeks of being approved to adopt?
Yes No
* Do you understand that Dog must be returned to S'Wheat Rescues if you cannot keep Dog at any time after adoption? Yes No
* Are you aware that there is a adoption fee in order to adopt through S’Wheat Rescues? Yes No
  Adoption fees are generally set as follows: $600 for purebreds under 1 year of age, $500 for purebreds 1-3 years of age, $300 for Wheatables (mixed breeds), Wheatens over 3 years of age or Wheatens with special needs or disabilities. All dogs will be up to date on shots and spayed or neutered prior to adoption. Any known health issues will be discussed prior to adoption.
* Would you be willing to let a representative of S’Wheat Rescues visit your home by appointment? Yes No
  If not, why?
  How did you hear about us?
  Finally, is there any further information you would like to share with us?


By submitting this application, I declare that all of the above information I have given is true and complete. I certify that I am applying to adopt this dog as a family pet for myself only and that the Wheaten will not now or at any time in the future be transferred to any other individual, research or rescue organization. I understand that any misrepresentation on this application constitutes fraud and the rescue Wheaten can and will be recovered by S’Wheat Rescues with no refund of the adoption fee.
* Do you agree to these terms? Yes No
  Please enter the letters in the security image:

If you would like a copy of this form for your records, please print the form now, before submitting.