Cavalier Rescue Coalition Adoption Application

Adoption Application
Please fill out the entire application. All questions marked with a ( * ) are required and they must be answered. If they are not, the application will not submit. If any of those marked required do not pertain to you, mark (N/A) in order to move forward with the application process. If there's a follow-up question to a required field, it's required also.
Applicant's Name*

First NameLast Name
Occupation and Age*

OccupationAge
Contact Information*

EmailCell Phone
Spouse/Partner's Name (Type N/A if None)*

First NameLast Name
Occupation and Age (mandatory if you have a spouse/partner)

OccupationAge
Contact Information (mandatory if you have a spouse/partner)

EmailCell Phone
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Is there a specific dog that you are interested in adopting?
Dog's Name
If unavailable what would your preference be? (Check all that apply)*

FemaleMaleEither Male/FemalePuppy (less than 1 yr.)Adult (1 yr - 8 yrs)Senior (8+ yrs)Any Age
Do you have experience with special needs and/or senior dogs? (Check all that apply).*

Mitral Valve DiseaseDeafnessBlindnessAllergiesDry EyeDiabetesSyringomyelia (SM)Chiari Malformation (CM)Episodic Falling DisorderSeizures or Flycatcher's SyndromeSurgery Rehabilitation (patella, hip, spine, etc.None
Do you have experience with correcting behavioral issues? (Check all that apply).*

BarkingBeggingMarkingSeparation AnxietyDestructive ChewingLeash AggressionPulling on the LeashJumping on PeopleExcessive LickingResource Guarding (Food, Toys, Treats, Space, People, etc.)Eating Things They Shouldn'tPlaying Too RoughlyNone
Please tell us a little about yourself and why you think you'd be a good home for a rescue dog.*
Tell Us About Your Family
List the Names, Ages, and Relationship to you of any additional adults who live in your home.*
Name, Age, Relationship
List the names, ages, and relationship to you of any children under the age of 18 yrs. who live with you or who visit your home on a regular basis. *
Name, Age, Relationship
Are you currently expecting a child?*

YesNo
Have you, or anyone living in your home, ever been convicted of animal cruelty, neglect, or abandonment?*

YesNo
Have all residents of the home agreed to caring for and loving a new dog for 10+ years?*

YesNo
Have you ever given a pet away to another person, shelter, or rescue group?*

YesNo
If yes, please explain.
What circumstances would cause you to return a dog to us in the future?*
Tell Us About Your Home
Do you Own or Rent your home?*

OwnRentOther
Choose which best describes your living situation.*

HouseCondoApartmentTownhouse
If a rental, does your lease permit you to have animals?*

YesNoYes/LimitedNot a rental
If living in an apartment/condo/rental property are there any restrictions on dog ownership or breed? Mandatory if living in an apartment/condo/rental. (Explain)
Landlord's Name (Mandatory if Renting)

First NameLast Name
Landlord's Phone (Mandatory If Renting)
Phone
Do you have a fenced yard?*

YesNo
If yes, please describe the type & height of the fence and any additional security measures taken to prevent pets from escaping or being harmed by predators. If no, explain how you will exercise the dog and handle toilet duties.*
Are there stairs in your home? (Check all that apply)*

No Stairs2nd Floor3rd FloorAccess to Yard
Does anyone smoke inside your home?*

YesNo
Tell Us About Your Adopted Pet's Lifestyle
On average, how many hours a day will the adopted dog be home alone without an adult over the age of 21 present?*

1 - 2 hrs.2 - 4 hrs.4 - 6 hrs.6 - 8 hrs.8 or more hrs.
Where will the adopted dog spend the day? (Check all that apply)*

Loose IndoorsLoose OutdoorsOutside KennelBasementGarageBedroomBathroomLaundry RoomKitchenFamily RoomTied Up OutsideDoggy DaycareFenced Yard (Supervised)Fenced Yard (Unsupervised)Other
Where will the adopted dog spend the night? (Check all that apply)*

Loose IndoorsLoose OutdoorsOutside KennelBasementGarageBedroomBathroomLaundry RoomKitchenFamily RoomTied Up OutsideFenced YardOther
Are you familiar with Mitral Valve Disease in Cavaliers and aware that your rescue dog may need regular appointments with a veterinary cardiologist in the future?*

YesNoNo, but I'll do some research before adopting
Are dogs allowed on the furniture in your home?*

YesNo
On a scale of 1 (no ability) - 10 (very proficient), how would you rate your ability to teach a dog basic commands such as sit, stay, down, come, etc.?*
On a scale of 1 (no ability) - 10 (very proficient), how would you rate your ability to housetrain a dog?*
Will you take the adopted dog to obedience training?*

YesNoIf Needed
What is your family's typical daily schedule (comings/goings, work/school, and weekends)?*
How will your pet be cared for during the times when the responsible parties are out of town (business, vacation, etc.)?*
If you move, what will you do with your adopted dog?*
Tell Us About Your Current & Previous Pets
Do you currently have pets in the household?*

YesNo
If yes, complete the information below for CURRENT pets. Provide the breed for all dogs owned.
Have you ever taken any obedience training with your dogs?*

YesNo
Do any of your current pets have behavioral issues?*

YesNoNo current pets
What behavioral issues do your current pets have? (Check all that apply).*

BarkingBeggingMarkingSeparation AnxietyDestructive ChewingLeash AggressionPulling on the LeashJumping on PeopleExcessive LickingResource Guarding (Food, Toys, Treats, Space, People, etc.)Eating Things They Shouldn'tPlaying Too RoughlyNoneNo current pets
Please describe all issues checked above.
Please be specific with your description.
What brand and type of food is your current dog(s) eating?*

BrandType (wet, dry, freeze-dried, grain-free, raw, home-made, etc.)
How will you walk the adopted dog?*

On LeashOff LeashDon't Walk the Dog
Are your pets up to date on vaccinations?*

YesNoSome not AllNo current pets
Is your dog on heartworm preventative?*

YesNoDon't currently own a dog
What was the date of your dog's last annual physical? Mandatory if you currently have a dog.

MonthDayYear
Do any of your dogs have medical issues?*

YesNoDon't currently own a dog
If yes, please describe your dog's medical issues.
Please provide information on pets you've had in the last 10 yrs. that are no longer with you.*
Veterinarian Information

Please contact your vet and give them permission to discuss your pets with our representative.
Name & Address of Current Vet (Mandatory if you currently have pets).

Name

Street Address Line

CityState

Zip Code
Phone Number
Fax Number
Name & Address of Previous Vet (If you've recently moved and changed vets)

Name

Street Address Line

CityState

Zip Code
Phone Number
Fax Number
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The Cavalier Rescue Coalition, Inc. is a 501c3 non-profit whose mission is focused on Cavalier King Charles Spaniels and Cavalier mixes of all ages, including senior and special-needs. We work to match dogs and families based on the best interest of the dog. A representative will be in contact with you if your application matches a dog in our program.

If you would like to learn more about our work, please visit our website at cavalierrescuecoaliton.org, review the resources provided and sign up for our mailing list.

If you would like to make a charitable donation, it can be sent via Paypal to cavalierrescuecoalition@gmail.com or via check to our corporate mailing address at 2422 Bridgewater Drive, Maidens, VA 23102.

My signature below certifies that the information that I have provided in this application is complete and correct. I understand that any false information I have provided will invalidate this and any future applications.

I further declare that I am financially and physically able to care for a rescue dog.

I understand that all dogs will be spayed or neutered prior to adoption or placed on a spay/neuter contract if the dog is too young to be altered at the time of adoption.

I agree to provide all pets with proper and sufficient food, water, shelter, companionship, humane treatment, and medical care.
Please sign below: *

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Adoption Application

Tell Us About Your Family

Tell Us About Your Home

Tell Us About Your Adopted Pet's Lifestyle

Tell Us About Your Current & Previous Pets

Veterinarian Information

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