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Columbus Cocker Rescue Adoption Application

. . . Our mission, not a business
Get A Printable Application that you can mail or fax to us by clicking here
Please Note
If your application is not completely filled out and/or your current or previous pets are (were) not up-to-date on their vaccinations and heartworm preventative and/or have not (were not) spayed/neutered, then your adoption application may be immediately denied without proceeding to the next step of the adoption process, unless there is a medical reason that can be verified
 
What Cocker are you interested in Adopting?:
YOUR INFORMATION
First Name: Last Name:
Street Address:
City: State: Zip:
Home Phone: Work Phone:
E-Mail Address:
EMPLOYMENT INFORMATION
Employer Name:
Employer Address:
Employer Phone: Time With Employer:
HOME INFORMATION
Number of Adults in Home: Number of Children in Home:
Ages of Children:
Activity Level In Home:
Type of Housing?:
Own or Rent?:
Note: If you rent, written permission from your landlord to have a pet will be required OR a copy of the lease
stating it is okay to have pet
Fenced Yard?:
What Type of Fence?:
Would you install a Fence if needed?:
What is your Household Income Level?:
 
Are you prepared to make a 10-15 Year Committment?:
If you move, would you seek Housing
where you could take your dog?:
Are you willing to work with Housetraining issues?:
How would you deal with Behaviour problems?:
Are you prepared to deal with vet costs?
If necessary due to sickness or injury are
you able to spend $500 or more for Vet care?:
Do you currently have any other pets?:
Please list any other pets - (Breed, Sex, Spayed or Neutered) Please give names, ages, and breed of any currently owned pets:

Have you previously owned a Cocker?:
Please list any previously owned pets - (Breed, Sex, Spayed or Neutered) Please give names, ages, and breed of any previously owned pets:
Why do you want to adopt a Cocker from us?:
Have you ever sold or given away a pet?:
If Yes, please explain the circumstances:
How many hours a day will the dog be alone?:
Where will the dog be kept when no one is home?:
Where will the dog sleep?:
Are you familiar with crate training:
If no, are you willing to learn?:
Is the dog allowed on the furniture?:
Who wil be primarily responsible for the dog?:
How will the dog be exercised?:
Under what circumstances would you give the dog up?:

What age dog do you prefer?:


Preferred color?:
If you can not adopt the desired
cocker, would you like us to keep your application on file?:
What do you see as desirable traits in your new pet?:
What do you see as undesireable traits in your new pet?:
COMMITTMENT
Are you willing to adopt a dog with minor health problems?:
Are you willing to adopt a dog with major health problems?:
Are you will to take your dog to obedience class?:
Most Cockers require professional gromming about
every 6 weeks, do you agree to have this done?:
How much do you anticipate spending on grooming each year?:$   Enter Numbers Only - No $ or no text, ex: 125.50
How much do you anticipate spending on dog food each year?: $   Enter Numbers Only - No $ or no text, ex: 125.50
How much do you anticipate speding on dog treats each year?:$   Enter Numbers Only - No $ or no text, ex: 125.50
How much do you anticipate spending on toys and bedding?:$   Enter Numbers Only - No $ or no text, ex: 125.50
REFERENCES
Two non-related personal references are required: The references listed must have seen the applicant interact with the applicant's current or previous pets
Reference One
First Name: Last Name:
Street Address:
City: State: Zip:
Home Phone:
E-Mail Address:
Reference Two
First Name: Last Name:
Street Address:
City: State: Zip:
Home Phone:
E-Mail Address:
VET INFORMATION
First Name: Last Name:
Practice Name
Street Address:
City: State: Zip:
Phone Number:
QUESTIONS OR COMMENTS
Is there anything we should know or any questions you may have?:
THE DETAILS
** Our adoption fee is $200-$250 Depending on Age, which includes grooming, a thorough physical exam including, but not limited to, skin, eyes and ears, spay/neuter, heartworm testing or treatment should they be infected, all vaccinations including Rabies to bring them up-to-date, and microchipping. All of our cockers are placed in a foster home for close monitoring and evaluation of housetraining and behavioral issues and receive a lot of personalized attention and unconditional love!!
CERTIFICATION

By signing my name below I certify that all information contained in this application is true and accurate. I understand that my references will be contacted and give permission for my vet to release any information requested by Columbus Cocker Rescue.

I understand accept that the adoption decision depends upon many factors, including – but not limited to the compatibility of the family and home to the individual cocker and other applications received on the dog. I understand and accept that is Columbus Cockers’ prerogative to decide which home is more appropriate for the individual cocker, and therefore, I will not take issue with the decision.

If you Agree with the above, please type "AGREE" Here
Enter Your Full Name:
Please enter the last 4 digits of your
Social Security Number for verification:
 
 
 
 

 
 
   
   
   
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