AMERICAN  COCKER  SPANIEL  RESCUE

ADOPTION  APPLICATION

Date: _________________                      

If there is a particular cocker available that you are interested in adopting, what is it's name?: _______________________

Applicant Name:_______________________________________

Co-Applicant:_________________________________________

Street:____________________________________________

City:______________________________State:__________Zip:_________

Phone:_______________________

E-mail Address:____________________________________

 

Applicant's Employer:_________________________________________________ Work Phone #:________________

Co-Applicant's Employer:______________________________________________ Work Phone #:________________

Have you ever owned a cocker spaniel before? please circle one:   Y / N

Is this dog going to be a gift?   Y / N

Do you have other pets?   Y / N    If yes, what kind and how many?_____________________________________________________

Do you live in a home or apartment?  _________________________ Do you own or rent?______________________

If renting, please give 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:

Do you have a securely fenced yard?  Y / N    If yes,how high is it? ____________What is it constructed of?_____________________

How many adults are in your household?  ____________________

How many children, and their ages?_______________________________

Do you have much contact with grandchildren or neighborhood/other children?  Y / N

How many hours will the dog be left alone during the day? ___________________

Where will the dog be kept during the day when alone? ____________________________________

Where will it sleep at night? _________________________________________________________

Does anyone in your home have any allergies to dogs?   Y / N

Where and how do you plan to exercise the dog?__________________________________________________________________

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?


 

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.

Are you willing to give the dog at least two to three months to adjust to a new environment?  Y / N

Are you aware that cocker spaniels need to be professionally groomed at 8 to 10 week intervals, depending on the coat -- and, are you able to accommodate this need? (Approximately $30 to $50 per grooming)   Y / N

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/date?

________________________________________         Are you interested in fostering a cocker spaniel?  Y / N

 

Please list below, three personal references.  If you already have a veterinarian, please also include them.

Name:_____________________________________________  Relationship to you:___________________________________

Phone #:___________________________________________

Name:_____________________________________________  Relationship to you:___________________________________

Phone #:___________________________________________

Name:_____________________________________________  Relationship to you:___________________________________

Phone #:___________________________________________

Veterinarian: _______________________________________    Phone #:___________________________________________

I understand that there is an adoption donation and the amount will vary from dog to dog. This could include vet fees for spay/neutering, vaccines, heartworm tests, and other vet fees and medications, microchips, ID tags, and grooming and housing expenses. This is necessary so that we can continue our efforts to help other cocker spaniels that need our assistance. Other expenses incurred are shelter fees to get the animals released to us, grooming supplies, transportation, flea treatments, disinfectants, food, etc.

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 American Cocker Spaniel Rescue.

I have read and understand all of this Adoption Application.

Any misrepresentation of the true facts, in this application or in the Adoption Agreeement, will invalidate the Adoption Agreement and will give the rescue group the right to reclaim the adopted cocker spaniel without refund of any donations.

I understand that American Cocker Spaniel Rescue will NOT be held responsible for damages that may be incurred by the adopted dog.

Applicant Signature:______________________________________________

Date:_________________

Driver's License #:_____________________________________State:__________ Date of Birth:________________

Co-Applicant Signature:___________________________________________

Date:_________________

Driver's License #:____________________________________State:___________ Date of Birth:________________

Your personal information will be kept confidential, and not shared with anyone outside of ACSR.

Return completed application to:

American Cocker Spaniel Rescue

C/O Terrolynn Guiles

624 191st Street Court East

Spanaway, WA  98387-4602

Or email to:

americancockerspanielrescue@yahoo.com

OR, FAX to:

775-249-5104