Application - Cocker Rescue of Florida

Please fill out our online application. We will check to see if you match the pet and if so, we will call you for an appointment.

Name of dog you wish to adopt *

Your Name *

Your Email *

Your Phone *

Your Address *

Your Age *

Marital Status *

Occupation(s) *

Employer *

Work Phone Number *

Working Hours *

How did you hear of us? *

Do you have a fenced in property? *

YesNo

Have you applied with another rescue for a dog? (If so who and when)

What type of living quarters do you reside? *

Do you own or rent? *

Would you allow us to make a home visit? *

[radio* home_visit use_label_element default:1 "Yes" "No"]

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? *

Describe your lifestyle (hours home, busy, etc.) *

Will your pet be included? *

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?

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 will the pet stay when you're on vacation or 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. *

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? *

If your pet(s) are no longer with you, why not? *

Do you give your pet heartworm medication? *

If so, what brand and where do you buy the medication?

Do you have your pets on flea/tick control? *

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? *

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? *

Do you have any additional comments or questions? *

Have you had any previous experience with owning a cocker? Tell us what if any. *

Do you have a fenced yard? If so what kind and size? *

Please add three references (Name, address, phone and relationship).

1st reference *

2nd reference *

3rd reference *

Adoption Form