Name of dog you wish to adopt
Your Name
Your Address
Your City
Your State
Your Zip Code
Driver License #
E-Mail Address
Home Phone
Cell Phone
Your Age
Marital Status
Occupation(s)
Employer
Work Phone Number
Working Hours
How did you hear of us?
Have you had any previous experience with owning a cocker? Tell us what if any.
Have you applied with another rescue for a dog? (If so who and when)
What type of living quarters do you reside?
\nSingle Family Home
Condominium
Apartment
Townhouse
Mobile Home
Villa
Do you have a fenced yard? If so what kind and size?
Do you own or rent?
\nOwn
Rent
Neither
Would you allow us to make a home visit?
Y esN o
How many adults live in your household and what is their relationship to you?
How many children are in your household, their relationship to you, and their ages?
How often do children visit you? (Including grandchildren)
Are you planning to have children & how soon?
Do any people in your household or regular visitors have allergies?
Do you or anyone in your home have health issues that would keep you from giving the dog a lifetime home?
Y esN o
Describe your lifestyle (hours home, busy, etc.)
Will your pet be included?
Y esN o
How many hours a day will your pet be left alone?
How much time will you be able to give your pet on a regular schedule or day?
When your pet is left alone, where will you keep him/her?
Where will your pet sleep at night?
Have you ever given up a pet? Why?
Where will the pet stay when you're on vacation or away?
How will you exercise your pet? By who?
Who will be responsible for the care of your pet?
Under what conditions would you give your pet away?
Where would you take your pet if you no longer were keeping it and why?
What would you do to correct behavior that is unacceptable? Have you done this in the past?
Will your pet be allowed on furniture?
Please list any current or past pets in the last 10 yrs and their ages, breed, neutered/spayed, sex, and size.
If your pet(s) are no longer with you, why not?
Please list the vets you have used in the past (Name of Vet, Phone Number, Name of Practice, Location)
Can we contact your vet for a reference? Would you still use the same vet?
Do you give your pet heartworm medication?
Y esN o
If so, what brand and where do you buy the medication?
Do you have your pets on flea/tick control?
Y esN o
If so, what brand and where do you buy the flea/tick control?
What brand of dog food do you feed and why?
Would you give your new pet 2 months for an adjustment period?
Y esN o
Will you accept a dog that is not housebroken and why?
What would you do to correct the following:
Barking:
Pee Pee on floor:
Shyness:
Snapping out of fear:
Chewing:
Owning a cocker you are required to groom your pet every 6 to 8 weeks. Does this present a financial problem? Grooming is approximately 40 dollars every 2 months.
Are you committed to giving this pet a forever home?
Y esN o
Do you have any additional comments or questions?
By submitting this application I give Cocker Rescue permission to check out my references and to do a home check. I agree to give any pet I adopt back to Cocker Rescue if I can no longer keep it. I understand any false information given to Cocker Rescue may result in Cocker Rescue reclaming the pet. If any court action is necessary that the new owner agrees to pay all court costs and attorney fees for Cocker Rescue. I understand that this is a legal substitution for my signature and can be used as a legal document. If all questions are not answered your application will not be accepted. All applications may not meet our requirements, Cocker Rescue reserves the right to refuse applications. If you do not hear back from us within 10 days your application was not approved. Please do not call us if approved we will call you to make an appointment to visit the pets.
