Select the type of application
Adopt
Foster

Applicant Information

First Name: Last Name:
Spouse or Partner's Full Name:
Names and ages of all persons residing in your home:

Address:
City: State: Zip Code:
eMail: Home Phone: Cell Phone:

Employer:
Address: Work Phone:
How Long?: Occupation:
Spouse Employer:
Address: Work Phone:
How Long?: Occupation:

Own or Rent home? Own Rent House Rent Apartment
If Renting: Is Pet Deposit Required? Yes No                 Is there a size limitation? Yes No
Name and Phone Number of Manager/Landlord: Phone:
Do you have permission from the Manager/Landlord to have pets? Yes No

Fenced Yard? Yes No            Is a swimming pool, spa or other body of water present? Yes No

Name of nearest relative not residing with you:
Address:      Phone:

Information on Current Pets

List the type, breed, age and sex of all pets currently owned.

Where does your present dog spend most of its time
Are all dogs and cats spayed or neutered? Yes No   If No, Why?
Are all dogs and cats on heartworm preventative? Yes No   What brand?
Are their medical records/vaccinations current for:   Parvo Yes No Don't Know      
Bordatello Yes No Don't Know               Distemper Yes No Don't Know
      Lepto Yes No Don't Know               Rabies Yes No Don't Know

What other dogs and/or cats have you owned in the past 15 years, and what happened to them?

Veterinarian's Name         Phone:

Life with a Cocker Spaniel

Which Cocker Kid(s) caught your interest?

Why do you want a cocker spaniel?

Have you ever had a Cocker Spaniel before? Yes No
If Yes, What happened to it / them?
Is this Cocker Spaniel a gift for someone? Yes No
Is everyone in your household aware and agreeable to adopting a Cocker Spaniel? Yes No
Are you financially capable of taking care of an ill or injured pet? (This can cost hundreds of dollars) Yes No
Where will you keep your pet during the day?
      during the night?
What will you feed your Cocker Spaniel?
Where will you have your Cocker Spaniel groomed?
      How often?
How many hours a day will your pet be without human companionship?
What will you do with your pet if you move?
If you leave town, who will care for your pets?
Who will take care of your animal if something happens to you?
Is anyone in your household allergic to dogs? Yes No
      if yes, please elaborate: