Cocker Spaniel Rescue of East Texas Adoption/Foster Application

Home Checks are done before placement.

You MUST read the adoption Contract and agree to its terms and conditions before your application will be considered.

You will be required to sign this agreement when you take possession of the dog.

READ THE CONTRACT

1. Do you want to Adopt, Foster or Both

Adopt Foster Both

2. In what dog(s) are you interested?

3. Name *

First Name Last Name

4. Age

5. Name of spouse or partner (first and last)

6. Spouse / PartnerAge

7. List full names, ages and relationship of all others living in the residence

8. E-mail address *

example@example.com

9. Cell Phone Number

10. Spouse/partner Cell Phone Number

11 Home Phone Number (if any)

12 a. Physical Address of Residence

Street Address

Apt. Number

City State / Province

Postal / Zip Code

12 b. Mailing Address (if different from physical address)

P. O. Box

Street Address Line 2

City State / Province

Postal / Zip Code

13. How long have you lived at this address?

14. Is there a fenced yard?

16. Is there a pool, spa or body of water present?

Yes No

17. Do you own or rent this residence

Own Rent

17a. If renting, do you have permission from the landlord to have a dog?

Yes No

17b. If renting, name of landlord/manager

Landlord phone number:

17c. If renting, is a pet deposit required?

17d. If renting, is there a size limitation or limit on the number of pets

Yes No

18. Have you adopted, purchased or otherwise acquired any animals in the last year?

Yes No

If YES, explain.

19, Have you applied within the last year to any other public or private animal adoption agency or Rescue Group?

Yes No

If YES, which ones?

20. Your Employer

21. How long?

Specify years or months

22. Employer address

23. Your Occupation

24. Work phone

25. Spouse/Partner Employer

26. How long?

Specify years or months

27. Employer address

28. Occupation

29. Work phone

30. If you are retired, please answer questions 20-29 based on your last employment.

Retired

31. Provide the name, address and phone number of a friend or family member not living with you.

Name

First, Last

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone

The following questions help us determine which dogs are the best match for your situation.

32. Are there children who regularly visit or stay overnight such as grandchildren, children who stay with you per a custody agreement, children you keep after school, etc ?

Yes No

33. What are their names, ages, relationship and frequency of visits?

34. Does anyone in the home vape or smoke?

Yes No

34a. If so, how many people?

35. Do any individuals in the home have disabilities that might affect the ability to properly handle and care for a dog?

Yes No

35a. Does anyone use a walker, wheelchair, motorized chair or cane?

Yes No

35b. Is anyone diagnosed with autism, ADD, ADHD, etc?

Yes No

35c. Does anyone suffer from Parkinson’s, MS, other neuromuscular diseases or dementia, including Alzheimer’s?

Yes No

35d. If you have marked YES to any of the above, please feel free to explain

36. List the name, breed, age and sex of all pets currently owned.

37. List the name, breed, age and sex of all pets owned in the last 10 years.

38. Where does/did dog spend most of its time when you are home?

Inside Outside

39. Where does/did dog stay when no one is home?

Outside Loose in the house Inside in a crate

40. Are all dogs neutered or spayed?

Yes No

41. If NO, why not?

42. Are all dogs on heartworm preventative?

Yes No

43. Which brand of preventative?

44. Are your dogs current on vaccinations for:

45. Vet Clinic Name:

45a Vet Name

45b. Vet Clinic Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

45c. Vet Phone Number

45d. Name Vet Records are under

45e. Names of Dogs in Vet Records

46. Why do you want a cocker spaniel? *

47. Have you ever owned a cocker spaniel before?

Yes No

48. Is this cocker spaniel a gift for someone?

Yes No

49. Is everyone in the household (spouse, children, parents, etc residing in your home aware and agreeable to adopting a cocker spaniel?

Yes No

50. Are you financially capable of taking care of a cocker spaniel – this can run $1,200 a year for grooming, heartworm prevention, and routine immunizations plus more if there are ear or eye infections or injuries.

Yes No

51. Where will your pet stay during the day?

Outside Loose in the house Crated in the house

52. Where will your pet stay at night

Outside Loose in the house Crated in the house

53. What do you feed your dog? If commercially prepared food, what is the brand such as Blue Buffalo, Science Diet, Pedigree etc.

54. Where will you have your cocker spaniel groomed?

54a. How often?

55. How many hours a day will your pet be without human companionship?

56. What will you do with your pet if you move?

57. If you leave town, who cares for your pets?

58. Who will take responsibility for the dog if something happens to you? Have you discussed this with them to confirm they will do so? Provide name, relationship and cell phone number for this person.

58a. Relationship:

58b. Phone Number:

59. Is anyone in your household allergic to dogs?

Yes No

59a. If YES, explain

60. If there is any other information you would like us to know about yourself, your home and family and why we should adopt to you please write us a note below.

P.O. Box 28, Sugar Land, TX 77487-0028 (713) 208-1314

Adoption Application