Street Address
City, State & Zip Code
Best time to call
Home Phone
Other phone / Cell phone
Email Address:
Place of employment & occupation
Work phone
Partner/Spouse Name & place of employment
Do either of your jobs require travel? If so, please explain how long absences generally are and who will care for your pet(s) while you are gone.
Tell us a bit about yourself, including your age.
Name and Breed of dog you would like to adopt? Would you consider another dog if the one named above were unavailable? If yes, what dog would you be interested in?
What do you think are the most important responsibilities in owning a pet?
Have you ever owned a pet before? If yes, please describe any pets that are currently with you (type, age, sex, altered status, etc)
Please describe any pets no longer with you and what happened to them.
Please provide the following information about your veterinarian: Name of Clinic/Vet Full address & phone number Also please call your vet and okay release of information to us.
How many people reside in your household?
Are there any children/grandchildren in the household? If yes, what are their ages and sex?
Do grandchildren ever visit? If so, how often and list their ages and sex.
Does anyone have allergies lving in your home? If yes, explain
Who will be responsible for feeding, housebreaking and training?
Do you own or rent your residence? If rent, please provide the name and phone number of your landlord.
Does your residence have a fenced yard? If yes, please state the size and type of fence, plus approximate size of yard. If no, please state how you will potty the dog.
Where will the dog stay during the day? ( be specific )
Where will the dog sleep at night?
How much time will the dog spend outside? (approx)
Will anyone be home during the day?
How many hours will the dog be left unattended in an average day? If at work, list normal hours.
When no one is home, where will the dog be kept (please be specific - crate, gated in kitchen, free to roam house, etc)
What do you intend to feed the dog? Please be specific
How will you housebreak the dog? (If applicable/Most rescued dogs will need) Are you familiar with crate trainging? What are your thoughts on it?
References: (Please use people that have known you at least 2 years & one being a neighbor) Name Phone Relationship to you Name Phone Relationship to you Name Phone Relationship to you
I understand that there is an adoption fee of $200.00 for cockers to partially defray costs of spaying, neutering, shots and heartworm testing.
I certify that I am at least 21 years of age and that I will be the legal owner of and, ultimately, soley responsible for the care and well-being of any dog I adopt from CockerPals Rescue.
Any misrepresentation of the true facts in this application or in the adoption agreement will invalidate the adoption agreement and will give Cocker Pals Rescue the right to reclaim the Cocker Spaniel without refund of the adoption fee.

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