Shorewood Cocker Rescue, Inc. Adoption Application

Thank you for considering adoption through Shorewood Cocker Rescue. The purpose of this application is to match the right dog with the right family and make sure your new family member fits well into your home. There are no right or wrong answers. We are simply trying to know more about you and your lifestyle so we can be sure to find the cocker you’re looking for. Please be sure to complete each part of the application fully or it may delay processing.

Have you read the ADOPTION PROCEDURE, if not please read it before going further.

Name:

Address:

City:

State:

Zip Code:

Telephone: (Home) (Work) (Fax)

Please list an email address you check regularly if at all possible. Otherwise list "None" (Email is our preferred method of communication).

Email:

How did you hear about us?

List members of your household including yourself.

Name: Age:
Name: Age:
Name: Age:
Name: Age:
Name: Age:
Name: Age:

Do you have children who do not live with you visit your home? If so, how frequently and what age range are they?

Do you rent or own?
Rent
Own

If you rent, do you have your landlord's permission?
Yes
No

Do you have a fenced in yard?
Yes
No

What type of fence? How high?

If no, how will your cocker be exercised?

Are you aware that there is a period of adjustment for each rescue animal to its new surroundings which may include potty accidents, chewing, shyness or other undesirable behaviors?
Yes
No

Are you willing to provide some training that might be needed?
Yes
No

Do all members of your family agree on getting a cocker spaniel or would some members prefer another breed or that you do not get a dog at all?
Yes
No, some members would prefer a different breed.
No, some members would prefer that we not get a dog at all.

Why do you think you want a cocker spaniel instead of another breed?

Have you ever had a cocker spaniel before?
Yes
No

If yes, please tell me all of its good and bad points.

If no, are you aware of the grooming requirements and common health problems?
Yes
No

Are you willing to adopt a dog with a special condition such as:
Blindness or vision impairment? Yes No
Epilepsy? Yes No
Hypothyroid? Yes No
Submissive wetting? Yes No

What is your preference for gender?

What is your preference for color? Second Choice?

Acceptable Age:

I understand that it is often hard to tell a dog's age if it was a stray.
Yes
No

What other pets have you owned (please give breed if dog, gender, and age)? Include all species.

Do you own them currently or where are they now?

If deceased what was the cause of death?

Are the other animals you currently own spayed or neutered?
Yes
No

What qualities are you looking for in a dog?

What characteristics do you hope to avoid?

If your cocker will be home alone during the day, how many hours per day?

Where will the dog be during the day, night, or when you are on vacation?

Will you allow the dog on your furniture?

What specifically do you plan to feed your dog? Please list brand name if a commercial dog food.

I understand that I will be put on a list of people who are wishing to obtain a dog. The family that is considered the best match between the dog and the adoptive family will be given the first priority to obtain the dog.
Yes
No

I agree to pay an adoption fee to help with the operating cost of rescue and to cover medical expenses and care of the animals. This adoption fee is not refundable.
Yes
No

The rescue feels in order to ensure that a home is the best fit for a dog, a home visit is required. Do you agree to a pre-placement home visit and/or follow-up visits?
Yes
No

Provide the following names and numbers (Please note that your application cannot be processed without reference checks):
1) Current or Previous Veterinarian:

Phone number:

Last name records are listed under:

Name of pet(s) and years owned:

2) Current or Previous Groomer:

Phone number:

Last name records are listed under:

Name of pet(s) and years owned:

3) Personal Reference (not a family member):

Daytime phone number:

Evening phone number:

4) If no Vet or Groomer, List a 2nd Personal Reference (not a family member):

Daytime Phone number:

Evening Phone number:

Date Applied:

Additional comments and/or questions:

Application fee was sent by:
PayPal
Mail

ALL OF THE INFORMATION I HAVE PROVIDED ON THIS APPLICATION IS, TO THE BEST OF MY KNOWLEDGE, TRUE AND COMPLETE. I UNDERSTAND FALSIFYING ANSWERS ON THIS APPLICATION, OR AT ANY OTHER TIME DURING THE ADOPTION PROCESS, DISQUALIFIES ME FROM ADOPTION.

Your application will be processed and responded to as soon as possible.

After submitting, you will first be taken to a confirmation page. Click the button "Continue" to confirm your entry. Once the form is processed, you will be taken back to the main screen. Please do not press the Back button until the form is processed and you are taken to the main page. Thank you.