Contact information

Your Name:

Address

City:

State:

ZIP:

E-mail address (required)

Home Phone:

Work Phone:

Best time to call:

Your Occupation:

Your Employers name and address:

Your Employers Phone:

Your Spouses Occupation:

Your Spouses Employers name and address:

Your Spouses Employers Phone:

Veterinarian's name:

Veterinarian's phone:

Veterinarian's Address

Vet records are in the name of:

About You:

Your Age:

Your Spouse's Age:

What type of accommodation do you live in:

Other 

Own or Rent?

Landlords Name:

Landlords Address:

Landlords Phone:

Do you have a securely fenced yard? If so, indicate size of garden and height of fence:

List people living in the home, ages, and relationship to adopter:

Do children visit your home? If so, indicate ages and relationship to you:

Working hours of adults in home:

Do you anticipate any major changes in your job or family in the next year?

About the pet:

Name or type of pet you are interested in:

Have you owned a Cocker Spaniel before? If so how did you select that breed?

Who will be primary care giver of animal?

Current pets living in the house and their ages:

Current pets living outside the house and their ages:

Which current pets have been spayed or neutered?

Are you sure your current pet will accept a new companion?

If you do not have a pet now, have you had one before? Please supply details:

Have you ever lost a pet?

Have any of your pets ever been killed by a vehicle?

Is the pet your are applying for going to be a gift?

If yes, who is it for and do they know they are receiving it?

If no, why do you want a new pet?

Where will the pet be kept during the day and at night?

How many hours will the pet be left alone during the day?

What will happen to your pet when you are on vacation?

When will your animal get exercise or outdoor time?

Are you willing to give the pet six weeks to adjust to new environment?

Will you accept a home visit?

Is anyone in your household allergic to animals?

List any characteristics of an animal that would not fit with your family or lifestyle:

Will you assume ALL financial responsibilities for your pet's vaccines, veterinary care, quality food and licensing?

Are you conversent with local and state animal laws and regulations?

Are you willing and able to work on house breaking or training issues with your new dog if necessary?

Are you aware that Cockers require regular monthly grooming?

Do you agree to provide regular grooming for any cocker that you adopt from us?

Do you agree to provide food, shelter and a safe environment for you cocker?

Do you agree that any dog adopted from cockers rescue will never be used as a guard dog?

Do you agree to give your new Cocker a loving home and never to abuse him/her in any way?

Do you agree that you or anyone in your household, or anyone that comes into contact with this dog will not harm him/her in any way?

Will you insure that the dog is never hit, smacked or physically hurt in any way for any reason?

Do you agree that if this dog does not work out for any reason you will return the dog to Colorado Cocker Spaniel Rescue?

References:

Please list contact details of two people that are not family and are pet owners that know you.

Reference one:

Reference two:

I certify that I am over 18 years of age, and the information I have provided is true and accurate. I give Colorado Cocker Spaniel Rescue permission to contact any of the contacts listed above. I understand and agree that if any information listed above is found to be false, this may lead to disqualification of my adoption application and nullify any agreements between the applicant or family and Colorado Cocker Spaniel Rescue.

I agree to abide by the terms of this contract with Colorado Cocker Spaniel Rescue, under penalty of forfeiture of the adopted animal.

SIGNED

DATE:   

Other information

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