Florida Coastal Cocker Rescue Adoption Application

Name of Dog(s) You Wish to Adopt*

Dog(s)

Adopter's Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

Employer(s):*

Working hours of adopter:*

Working hours of other adults in the home*

(Do Not leave this section blank! If you have NEVER had a pet; write “None.”)

Please provide your current and / or previous veterinarian’s information.

Have you ever had a pet in the past?*

YesNo

Veterinarian Name

First NameLast Name

Veterinarian Clinic Name

Clinic Name

Veterinarian Phone Number

Area CodePhone Number

Veterinarian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Do you provide monthly Heartworm prevention to your current (previous) dog(s)?*

YesNo

Please provide the name of the Heartworm Preventative you currently or have previously used*

Heartworm Preventative

Do you provide flea control to your current (previous) dog(s)?

YesNo

Please provide the type of flea control you currently or have previously used*

Flea Control

List the names and dates of birth for ALL people residing in the home, including self.*

Do children reside or visit your home? What ages?

Please explain why you would like a dog*

Please list all of the pets you have owned in the past 10 years; including type ofanimal, and status (current or deceased). If none, include pets owned during your adult life and any pet residing in your home that you didn't own*

Are all of your pets spayed / neutered / fixed?*

YesNo

Have you ever sold or given away a pet or surrendered one to a shelter?*

YesNo

If yes, please explain why

Are all of your pets current on their vaccinations?*

YesNo

If your pets are not current on their vaccinations, heartworm prevention or fixed, please explain why.*

Select the type of residence that you currently live in*

How long have you lived at this address?*

Do you own or rent?*

OwnRent

If you rent, please provide your landlord's name & phone number:

Landlord Name

First NameLast Name

Landlord Phone Number

Area CodePhone Number

Is your yard fenced in?*

YesNo

Fence Type:

Fence Height:

Feet

Are you willing and able to modify your daily schedule to accommodate the dog's needs; such as having to go out at least 5 times a day?*

YesNo

Are you aware of the importance of keeping a dog on a leash or in a fenced in yard when he/she is outside?*

YesNo

Where will the dog sleep?*

Will the dog be allowed to sleep in your bed?*

YesNo

Will the dog be allowed on your furniture?*

YesNo

Is anyone in your home allergic to dogs?*

YesNo

Where will the dog be kept when you are home?*

CratedLoose in homeRoom confinedYard

Where will the dog be kept when left alone?*

Room ConfinedYardCratedLoose in home

On average, how many hours a day will the dog be left alone?*

Hours

Would you accept a dog that is NOT reliable with children?*

YesNo

Would you accept a dog that has a health problem (mild or major)?*

YesNo

Who will be responsible for the care and training of the dog?*

AdopterOther adult in household

Do you/they have experience with dogs?*

YesNo

Are you willing to housebreak the dog, if necessary?

YesNo

What primary method of housebreaking will you use, or have you used in the past?*

How would you handle house training issues?

How would you handle adjustment training for jumping on people?*

How would you handle adjustment training for barking?*

How would you handle adjustment training for chewing?*

Knowing that some rescue dogs have little or no training, are you willing to take the dog to obedience classes?*

YesNo

Are you willing to give the dog time to adjust to a new environment?*

YesNo

List any preferences you have in adopting a dog.*

What characteristics would you find undesirable in a dog?*

Describe your lifestyle:*

Active: Hiking, camping, busy in community, in & out a lotRelaxed: Structured, quietOther

Will you include the dogs in your activities?*

YesNo

Taking into consideration that dogs vary greatly in temperament, personality, and activity level, please describe the perfect dog for your home. What characteristics do you want in a dog? Please answer in as much detail as possible.*

The basic needs of a dog are feeding, grooming, shots, heartworm protection which can cost approximately $800 - $1,000 per year. Unexpected medical issues can also be incurred, which can drastically increase this amount! Will you be able to accept this financial responsibility?*

YesNo

Most dogs, with good care, can live to be 13 to 15 years of age or older. Are you willing and able to commit to caring for your new pet for its full lifetime?*

YesNo

For what reason(s) would you consider returning/giving up your adopted dog?*

The process is in application review; if approved, the next step is a home visit, and finally a meet and greet with the dog.

We feel this process is imperative to assess the needs of both the dog and the potential adopter.

Keep in mind when we receive multiple applications, there are going to be disappointed people.

We reserve the right to refuse an application based on the application responses, home visit, or for what we feel is the best interest for the dog's needs.

FLORIDA COASTAL COCKER RESCUE, INC. IS A 501(C)(3) ALL VOLUNTEER NONPROFIT ORGANIZATION WHOSE MISSION IS TO RESCUE, REHABILITATE, AND REHOME COCKER SPANIELS IN NEED. A COPY OF THE OFFICIAL REGISTRATION (CH# 22507) AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES ON THEIR WEBSITE (www.fdacs.gov/ConsumerServices) OR BY CALLING TOLL-FREE 1-800-435-7352 WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL OR RECOMMENDATION BY THE STATE.

Please write any additional comments, questions, or concerns that you may have.

Additional Comments:

Adoption Application

Adopter's Occupation:

CURRENT / PAST PET INFORMATION