Columbus Cocker Rescue Adoption Application

We would like to express our sincere appreciation to everyone who participated and volunteer'd at Bark Park. Without all the love and support, we could not have had such a successful day! Thank you everyone from the bottom of our hearts!!!!

First Name:

Last Name:

Street Address:

City:

State:

Zip:

Home Phone:

Work Phone:

E-Mail Address:

Employer Name:

Employer Address:

Employer Phone: Time With Employer:

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?:

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?

How much do you anticipate spending on dog food each year?:

How much do you anticipate speding on dog treats each year?:

How much do you anticipate spending on toys and bedding?:

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:

First Name:

Last Name:

Practice Name

Street Address:

City:

State:

Zip:

Phone Number:

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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