| Applicant Information: |
| First Name | Last Name | Date : (dd/mm/yy) |
| Address | City | State Zip Code |
| Work Phone | Home Phone | E-mail |
| Applicant Employer | Work Phone |
| Co-Applicant Employer | Work Phone |
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| Referred by | Have you owned a cocker spaniel before? Yes No |
| Why do you want a cocker spaniel? |
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Please list the pets now in your home. | First Pet | Second Pet | Third Pet | Fourth Pet |
| Type/Breed: | | | | |
| Gender: | | | | |
| Spay/Neutered? | | | | |
| Age: | | | | |
| Owner since? | (mm/yy) | (mm/yy) | (mm/yy) | (mm/yy) |
| Comments: | | | | |
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Please list previously owned pets. | First Pet | Second Pet | Third Pet | Fourth Pet |
| Type/Breed: | | | | |
| Gender: | | | | |
| Spay/Neutered? | | | | |
| Age: | | | | |
| Years Owned | | | | |
| What happened to them? | | | | |
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| Who is your Veterinarian? | Phone |
| Address | City | State Zip Code |
| If you have a pet(s), when was the last visit to the Veterinarian? |
| What shots did it/they have last year? | Was it tested for Heartworm? Yes No On Heartworm preventative? Yes No If yes, what kind? |
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| What kind of home do you reside? House Apartment Condo Mobile Home Other (explain) |
| Do you own or rent? Own Rent |
| If renting, please give the landlord's name, address, and phone number. We require landlord's written consent for your having a dog. Please include this consent when you submit this application Landlord's name: Address: Phone |
| If you live where there is a Home-Owner's Association, what are the restrictions regarding pets? |
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| If you own your home, please provide the name of the municipality in which you live (township or boro) and a phone number to contact the zoning officer. (If you have multiple pets, we need to be sure it is permitted.) | Municipality: Phone: |
| Do you have a securely fenced yard? | Yes No | How high? |
| What is it constructed of? | | If not, are you willing to fence? Yes No |
| Are you willing to install a pen or run? | Yes No | Or to leash walk at all times? Yes No |
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| How many adults are in your household? | Ages of adults: | |
| How many children in your household? | Ages: | |
| Is this dog primarily for a child? | Yes No Age of Child: | |
| Do you have much contact with small children (i.e., grandchildren, neighborhood/other children) | Yes No |
| What are the working hours of the adults in the household? applicant: | co-applicant: |
| Where will the dog be kept when left alone? |
| Where will the dog sleep at night? | |
| Who will be primarily responsible for the care of the dog? |
| Where and how do you plan to exercise the dog? |
| This dog will be left alone without human companionship, for about hours a day |
| Does anyone in your home have any allergies? Yes No | |
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| Please describe your lifestyle. Is it active? (e.g. hiking, camping, busy in the community, in and out a lot) OR is it a more relaxed, structured atmosphere? |
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Please describe the perfect dog for your home. Taking into consideration that cockers vary greatly in temperament, personality, and activity level, what characteristics do you want in your dog? Please answer in as much detail as possible. |
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What characteristics are undesirable? | |
| Up to what age are you willing to accept? | Would youacceptadogthat is older? | Yes No |
Are you willing to accept a dog that: | | |
is not reliable with children | Yes No | |
has been abused | Yes No | |
has a physical handicap | Yes No | |
Knowing that some rescue dogs have had little or no training, are you willing to take the dog to obedience classes? Yes No |
| Are you willing to housebreak a dog, if necessary? Yes No | |
| What housebreaking methods have you used in the past? |
| Explain your opinions and understanding of "crate training" | |
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What is your understanding of the care a cocker spaniel requires? Grooming, diet, ears, etc | |
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If you currently have other dogs and/or cats in your home, explain how you would go about introducing a new dog to your current animals. |
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What would you do with the animals when you are not there, until they are acclimated to each other? |
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Should a fight occur between pets, how would you handle it/break it up? |
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How would you handle adjustment/training problems, such as: |
Jumping on furniture? | |
Jumping on people? | |
Barking? | |
Chewing? | |
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| Are you willing to give the dog at least two to three months to adjust to a new environment? | Yes No |
Cocker spaniels need to be professionally groomed at 4 to 6 week intervals, (depending on your dog's coat), at a cost of approximately $30 to $50.
Does this present a problem? Yes No |
The basic needs of a Cocker (feeding, grooming, vet care) average $800 to $1000 per year. Any special problems could increase this amount.
Does this responsibility present a problem? Yes No
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Our adoption process includes a visit by a representative to your home to meet all members of your family. When would be the best time? |
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| If you are interested in a particular dog, which one? |
| If not a particular dog, what gender, color, and age are you looking for? |
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| The following section requires your electronic initial/signature. Your electronic signature is valid as an authorized form of acknowledgement. |
I understand there is an adoption donation of $200 which includes vet fees for spay/neutering, vaccines, heartworm tests, vet fees and medications; ID tags, grooming, and housing expenses. This is necessary so we can continue to help other cocker spaniels needing our assistance. | Initials: |
I certify that I am at least 21 years of age and that I will be the legal owner of and ultimately, solely responsible for the care and well-being of any dog I adopt from Friends of Cockers Rescue. | Initials: |
I have read and understand all of this Adoption Application. | Initials: |
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Any misrepresentation of the true facts, in this application or in the Adoption Agreement, will invalidate the Adoption Agreement and give Friends of Cockers Rescue the right to reclaim the adopted Cocker Spaniel without refund of any donations. |
| Applicant Signature: Co-applicant Signature: Date: Date: Driver's License #: Driver's License #: Issuing State: Issuing State: Date of Birth: Date of Birth:
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