Rosie's Cocker Rescue Referral Application

blue cockers

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Happy Tails!!!

Bart

Bart

Peanut

Max
Adoptable!
Click on me to go to my Petfinder Page!

Fat Buddy
Special Needs
Sponsorable!

Babe

Babe
18 years old
Hospice Case
Sponsorable!

RCRR Application Form:

Please complete each question on this application. Incomplete Applicatons will not be considered. Please answer each question in as much detail as possible, providing phone numbers and appropriate contact persons as requested. Information will only be used to guage the suitability for pet adoption.

YOUR BASIC INFORMATION:

Name:
Email:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Cell Phone:

Please check one:
I am applying to be approved for adoption when "the right dog" is available, or I am applying to be a foster parent.
I am applying to be approved to adopt a specific dog seen on Petfinder.

Dog's Name #1:
Dog's Name #2:

1. Why do you want to adopt a dog?

2. What do you think are the most important responsibilities in owning a dog?

3. Why do you want to adopt a Cocker Spaniel in particular?

4. How long has it taken you to decide to adopt a Cocker Spaniel?

5. Are you willing to take the time to work with a dog on housebreaking issues, should the need arise?
yes no

6. Do you understand and accept that changing a dog's environment may cause the dog to have accidents, especially in the early days of the adoption?yes no

7. If a behavioral problem arises, what steps will you take to work on it?

8. Does any member of the family have any allergies to animals? yes no

    If yes, please explain:

9. For whom are you adopting the dog? selfgift

10. Have you ever owned a pet store before? yes no

      If yes, what kinds of animal(s) and when?

11. Do you currently have any pets or have you had pets in the past? yes no

Please describe any pets you still own, in as much detail as possible (type, age, sex, etc.).

12. Is/are the animal(s) spayed/neutered? yes no

13. Which pets do you no longer own?

14. What happened to him/her/them? If they died, please indicate at what age and the cause of death.

15. Were they spayed/neutered? yes no

16. Have you ever given any of your animals away for any reason?
yes no

   If yes, please explain the reason(s):

17. What do you consider a good and valid reason for giving up a dog?

18. What is the name and contact information of the veterinary hospital where your animal(s) has/have received care and vaccinations?

Name:
Email:
Address:
City:
State:
Zip:
Phone:

19. Do you have a different vet in mind for your new pet? yes no

     If yes, please specify, and kindly say why you are changing vets.

20.    What kind of veterinary care do you intend to provide?

21.    Have you done or do you intend to do any reading in preparation for a new dog? Please specify:

22.    Will you consider obedience training for your dog? yes no

23.    Do you have any experience with obedience training? If so, please specify:

24.    Would you be willing to obtain a crate if recommended for the dog? yes no

25.    How many people currently reside in your household?

26.    Is everyone equally enthusiastic about adopting a dog? yes no

Please explain your answer:

27. How would you describe the activity level in your household?

28. Are there any children in the home? yes no

29. If yes, what are their ages?

30. If there are children in the home, do any have experience with animals? yes no

If yes, please provide some details:

31.    Do children visit your home regularly or occasionally?
yes no

If yes, please explain:

32.    Who will be responsible for feeding the dog and taking him/her outside?

33. In the absence of the primary caretaker, who will take care of the dog?

34. Do you own or rent your residence? own rent

35.    If you rent, what is the name of the landlord and contact information?
Name:
Email:
Address:
City:
State:
Zip:
Phone:

Are pets allowed? yes no

36. Do you live in a:

Single family home    Duplex

Townhouse        Mobile home

Condominium       Apartment

Other (please explain):

37. Are there any restrictions or covenants where you live?
yes no

If yes, please list them:

38. Do you have a fenced yard? yes no

39. If yes, how high is the fence?

What type of fence is it?

Any holes or gaps or weak areas?

If you do not have a fence, do you plan to get one? yes no

If so, when?

If not, why not?

40. Would you walk/exercise a dog on or off-leash or both?

41. Where will the dog be kept? indoors only outdoors only both in/out (explain):

42. How much time will the dog spend outdoors and why?

43. Will anyone be home during the day? yes no

How many hours will the dog be left unattended?

44. When you are home, where will the dog be kept?

45. When no one is home, where will the dog be kept?

46. Where will the dog sleep?

47. Are you willing to keep a collar with a tag bearing your name and phone number on your dog at all times?   yes no

48. How often and for what reasons do you travel?

49. What will you do with the dog when you travel?

50. What will you do with the dog if you move/change housing?

51. Are you or your spouse with the military? yes no

52. Have you ever bred or raised dogs? yes no

53. Have you ever participated in dog shows? yes no

54. Please estimate the annual cost of the following:

-- Premium Food (Many Cockers require veterinary diets)

-- Grooming (Every 6-8 weeks, minimum)

-- Vet Care (including necessary shots, heartworm preventative, ear, eye and teeth maintenance)

-- Extras (Toys, treats, beds, bowls, leash, collar, id tag)

55.    Are you able to comfortably provide the estimated care, and are you prepared for possible other costs, in addition to your estimation? (Examples: sickness, accidents, emergency care).
yes no

56.    Are you aware and do you accept that all rescues that RCRR works with require that all dogs and cats in the household be spayed/neutered before an adoption of a dog can take place?
yes no

57.    Are you aware and do you accept that all rescues that RCRR works with require adoption fees ranging between 150 and 300 dollars?
yes no

58.    The average Cocker Spaniel has a lifespan of 12 to 15 years. Are you willing to make a commitment to this dog for the rest of his/her life? yes no

59.    Are you willing to provide the necessary love and attention, as well as the necessary food, vet care, and grooming required to maintain a happy, healthy Cocker Spaniel? yes no

60.    If this is a long distance adoption, are you willing to:
Travel to get the dog (by plane or car or both?)
Pay for the costs of transportation.
Meet somewhere along the way.
Unable/Unwilling to travel or assume costs.

61. Do you understand and accept that you will need to sign an RCRR adoption contract if approved?
yes no

62. If, for any reason, you are unable to keep your dog, do you agree to notify RCRR immediately?
yes no

63. If you are unable to keep your dog, do you agree to return him/her to RCRR without hesitation?
yes no

64. If this is a long distance adoption, and you are unable to keep your dog, are you willing to assume the responsibility, including travel and financial responsibility, for returning the dog to RCRR? yes no

65. Please list any preferences you have in adopting a dog (age, sex, breed, personality, etc.):

Is there anything else you would like to add?:

Our Support

Rosie's Cocker Rescue Referral is supported by the artwork of Rosie Griffeth, the delicious jams, jellies and goat milk fudge produced at Old Maid's Aerie Farm and Jammery, Rosie's hand-crafted all natural soaps and the kind donations of people just like yourself. Please consider sponsoring one of our special needs dogs or donating pet supplies to RCRR. If we don't have need of it, we are happy to send it on to another responsible rescue who does!

Rosie's Cocker Rescue Referral
Hartford, TN 37753
Phone: 423-487-0290

Email: rosiewlf@gmail.com
Click here for a list of pets at this shelter

white cockers

Rosanne Griffeth, 2006
Petfinder ID: TN327
423-487-0290

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