Adoption Application
Email Address:
Name
Address
City
State
Zip
Home phone
Work number
Cell phone
List other members of your household.
Do you own or rent?
Landlord name and phone number
Are there any restrictions on pets ?
Do you have a fenced in yard ? How high and what material is the fencing.
Do you have any plans on moving ?
Do all members or your household agree on getting a cocker ?
Does anyhone have any allergies ?
Have you had pets in the past ?
Do you have any pets now? If so, what kind ?
Are you willing to take a dog that might have special needs ie? seizures, thyroid, cataracts/ PRA, shyness, or help with housebreaking ?
References
Vet Name
Phone number and contact name
What name is the account under ?
Groomer Name
Phone number
Personal References
Name
Phone
Relationship
Name
Phone
Relationship
Name
Phone
Relationship
Is there a particular dog you are interested in ? If so, which one.
Have you contacted any other cocker rescue groups? If yes, which one(s) ?
I understand that I will be put on a list of people who wish to obtain a dog. The family that is the best match will be given priority for the dog.
I agree to pay an adoption fee to help in the operating cost of rescue and to cover medical expenses and care of the animal.I have read the above information carefully and have answered the application honestly. I understand that omission of information and/or failure to answer all questions can result in this application being declined. If an omission or untruth is discovered after an adoption occurs, I understand and accept that Wisconsin Cocker Rescue had the right to annul the adoption and reclaim the dog.
Date
Need assistance with this form?
Report abuse
