Gulf Coast Cocker Spaniel Rescue

Thinking about owning a cocker spaniel? Be in the know about this wonderful and special breed, check out this handy COCKER SPANIEL FACT SHEET!

ADOPTION APPLICATION

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Please fill in the blanks then click on submit. Please note that clicking on reset will clear the form and you will have to start over!

If you will be a first time Cocker Spaniel Owner, please read our Cocker Spaniel Fact Sheet HERE before submitting your application.

PLEASE READ THE FOLLOWING CAREFULLY:

Gulf Coast Cocker Spaniel Rescue, Inc. (“GCCSR) thanks you for seeking to adopt a rescue animal. Our goal is to place our rescued pets in permanent, loving homes. We understand this application/contract is lengthy, but it has been formulated in hopes if minimizing the risk of a failed adoption. Please complete this application/contract so that we at GCCSR can assist you in finding a special, compatible companion to join your family.

We do not adopt dogs on a “first come, first served” basis, but rather make every attempt to match families with the most compatible pets. The primary adoption fee for pets is $200.00 for cocker spaniels 6 months of age and older. The fee for puppies under 6 months old is $300.00, and placement is done only on a foster-to-adopt basis until sterilization is completed at one of GCCSR’s veterinarians. After surgery, the adoption will be finalized upon receipt of the $300.00 adoption fee and co-signing of the contract by a GCCSR representative.

Because the animals in GCCSR’s adoption program are rescued, we do not know their actual ages. The approximate age of the pet in which you are interested is estimated using our experience and the advice of our veterinarians. Often times, different veterinarians may approximate different ages for the same pet, which may appear on their respective records. GCCSR thus uses reasonable efforts to approximate an appropriate age, but makes no affirmative representation that the approximate age is the actual age of the pet.

By signing this application, you as the adopter agree that in the unfortunate event you should you decide not to keep your pet for whatever reason, you will immediately contact a GCCSR representative and return the pet to GCCSR.

GCCSR has the right to either deny or approve applications without explanation. Approval should not be construed to mean the applicant can select any dog. If we feel a specific dog is not a good match, we may still decline to adopt that particular dog to you.

PLEASE NOTE YOU MUST FILL THE CHARACTERS AT THE BOTTOM OF THE FORM TO COMPLETE YOUR SUBMISSION. IF YOU ENCOUNTER PROBLEMS, PLEASE EMAIL US AT gulfcoastcsr@hotmail.com

ADOPTION APPLICATION / CONTRACT

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Your Email:

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Date of Application

Name

Name of Dog in which you are interested

Male /Female

Part I Veterinary Reference/Release

I hereby give my permission for any veterinarian providing service to me to release medical information on any/all of my animals to Gulf Coast Cocker Spaniel Rescue Signed

My Current Veterinarian is

Located at

Phone number

Part II Your Pet Ownership History (Please Be As Specific As Possible In Your Answers)

Do you or have you had other pets?

If you answered yes to the above question, please state the breed, sex, etc. of each pet, including whether it was spayed or neutered and on heartworm preventative, how and when the pet was acquired and why you no longer have the animal. (if applicable)

Name of Pet:

How Acquired?

Breed?

Sex

Spayed/Neutered?

Current Age of Pet

Length of Ownership:

On Heartworm Preventative?

Is your pet current on all shots?

If no, please explain:

Where does/did this animal sleep?

Where does/did the animal stay while you were away or at work?

Does/did this pet have any problems or conditions?

If you no longer have this pet, what happened to it?

Please click the Add More Pets link in the right hand corner of this section to add additional pets.

Part III Information About You

Are you over 21 years of age ?

Spouse/Partner's Name:

E Mail address- Please complete so we can email you vet records.

Postal Address Street City State and Zip

Home Phone

Work Phone

Cell Phone

Employer

How long? Occupation?

Employer's Address (Street, City, State & Zip)

Name of nearest relative not residing with you:

Relative's Phone Number:

Spouse/Partner Work or Cell Phone Number

Part IV Information About Your Family

Do you live alone or with Family ?

Does everyone in the household agree to owning this pet ?

Is any one in the family allergic to animal dander?

Do you Have any Children/Grandchildren ?

What ages ?

Do they live in the household ?

If they do not live with you how often do they visit ?

Part V: Information About Your Home

Do you Own or Rent ?

Home or Apartment ?

If renting how long at this location

If renting does your lease allow pets ?

Breed or weight restrictions ?

Manager/Owners Name (We will need conformation of any pet deposit)

Phone Number

Do you have a fenced yard ?

What type of fence and how tall

Part VI: Information About Leaving/Housetraining/Exercising/Obedience Training Pet

How long will the pet be left alone ?

Where would the pet stay?

Do you or your spouse/partner travel frequently ?

If so how often ?

What will you do with the pet while you travel ?

What will you do with the pet if you move ?

Are you willing to purchase a Crate if advised ?

Do you have a pet door ?

Have you house trained a pet before ?

How did you accomplish this ?

How would you exercise this pet ?

Are you willing to commit to behavior and/or dog obedience training ?

Where would the pet sleep?

Part VII: Information About Your Experience with Animals/Your Expectations and Permission for Home Visit

Have you owned this breed/mix before?

Have you owned a rescue animal before ?

Have you ever adopted from a rescue group or shelter?

If so what group or shelter ?

Have you applied to adopt and been declined ?

If so why ?

Have you ever given up animals ?

If so why ?

If so what did you do with the animals ?

What qualities are you looking for in a pet ?

What traits are you sure you do not want ?

What activity level are you looking for in a pet ?

Do you give your permission to a GCCSR Representative to visit your house prior to an adoption to do a home check and after the adoption to do a follow up checks on the pet?

Part VIII: Life With A Cocker Spaniel

Is this Cocker Spaniel a gift for someone?

Are you financially capable of taking care of an ill or injured pet? (This can cost hundreds of dollars)

What would you consider a major medical expense you could not afford?

What will you feed your Cocker Spaniel?

Where will you have your Cocker Spaniel groomed?

How often will you have your Cocker Spaniel groomed?

Who will take care of your animal if something happens to you?

Part IX: Adoption, Release and Indemnity Agreement

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A Binding Agreement is made as of the date set forth below {Note: A binding agreement is only Consummated once a Gulf Coast Cocker Spaniel Rescue Representative Signs below } WHEREAS the adopter wishes to take custody of the following pet:

Name of Pet

Sex

Color

Age Estimated

Altered ?

Heart Worm Status

Date of Test:

Part X: Agreement

Enrollment in pet recovery services provided by HomeAgain, Avid or ResQ is included in your adoption fee. GCCSR will remain as the Primary contact and Adopter will be enrolled as the alternate contact. NOW, THEREFORE, for and in consideration of GCCSR's relinquishment of custody of Pet and other good and valuable consideration provided to Adopter by GCCSR, which Adopter acknowledges is good and sufficient consideration for Adopter’s agreements herein, Adopter hereby gives and grants GCCSR unto, as a basis on which Pet is released, this Adoption, Release, and Indemnity Agreement, and promises, covenants, and agrees as follows:

HOLD HARMLESS/ INDEMNIFICATION GULF COAST COCKER SPANIEL RESCUE AND ITS OFFICERS, BOARD OF DIRECTORS, VOLUNTEERS, AFFILIATED ENTITIES, AND/OR AGENTS) SHALL NOT BE LIABLE TO ADOPTER ON ANY THEORY OF LEGAL LIABILITY INCLUDING BUT NOT LIMITED TO THE NEGLIGENCE OF GULF COAST COCKER SPANIEL RESCUE (AND/OR ITS OFFICERS, BOARD OF DIRECTORS, VOLUNTEERS AND/OR AGENTS), FOR ANY INJURY, DEATH OR DAMAGE DIRECTLY OR INDIRECTLY CAUSED BY PET. ADOPTER DOES HEREBY RELEASE GULF COAST COCKER SPANIEL RESCUE AND ITS OFFICERS, BOARD OF DIRECTORS, VOLUNTEERS AND/OR AGENTS) FROM ANY AND ALL LIABILITY, CLAIMS, SUITS, OBLIGATIONS, DEMANDS, OR CAUSES OF ACTION, KNOWN OR UNKNOWN, FORESEEN OR UNFORESEEN, ARISING OUT OF OR RELATING IN ANY WAY TO THE PET OR GULF COAST COCKER SPANIEL RESCUE’S RELEASE OF PET TO ADOPTER. IT IS THE EXPRESSED INTENTION OF ADOPTER AND GULF COAST COCKER SPANIEL RESCUE THAT THE RELEASE PROVIDED FOR IN THIS PARAGRAPH IS DESIGNED AND INTENDED TO PROTECT GULF COAST COCKER SPANIEL RESCUE (AND ITS OFFICERS, BOARD OF DIRECTORS, VOLUNTEERS, AND/OR AGENTS) FROM ANY PERSONAL INJURY CLAIMS BY ADOPTER OR OTHERS AND FROM THE CONSEQUENCES OF ANY HARM, BEHAVIOR, OR OTHER ACTION BY PET, AND FROM THE CONSEQUENCES OF ANY ACT OR OMISSION OR NEGLIGENCE ON THE PART OF GULF COAST COCKER SPANIEL RESCUE (AND ITS OFFICERS, BOARD OF DIRECTORS, VOLUNTEERS AND/OR AGENTS) IN OBTAINING CUSTODY OF PET, IN PROVIDING CARE FOR PET, IN TRAINING OR NOT TRAINING PET, OR IN FAILING TO PROVIDE TIMELY OR ADEQUATE WARNING TO ANY PERSON CONCERNING PET. * ADOPTER'S INITIALS:

ADOPTER further promises, covenants and agrees (please initial by EACH applicable promise, covenant and representation): To pay an adoption fee in regards to this Adoption prior to the transfer of said pet to the Adopter. The adoption fee is NON-REFUNDABLE even if the Pet is returned to Gulf Coast Cocker Spaniel Rescue.

To NEVER sell, trade, or give away the Pet to anyone. I will never relinquish this Pet to any shelter or pound, whether “no-kill” or otherwise. I will notify Gulf Coast Cocker Spaniel Rescue if I am unable or unwilling to keep this Pet and I will return this Gulf Coast Cocker Spaniel Rescue after arrangements have been made for such return. If this Pet is lost or stolen, I will notify Gulf Coast Cocker Spaniel Rescue with in twenty-four (24) hours of the Pet’s disappearance

That all future medical and health maintenance treatments are my responsibility, unless GULF COAST COCKER SPANIEL RESCUE has specifically agreed in writing to pay for them under the “special provisions” at the end of this contract. I will seek immediate (at time of injury or signs of illness) veterinary care if this Pet becomes ill or is injured. I understand this is for the lifetime of the Pet will administer monthly heartworm preventative to the Pet year round. If the Pet is heartworm positive, I understand that Heartgard® (or its ivermectin equivalent) is the only preventative/treatment that may be administered. Any other type of heartworm treatment or preventative could cause the Pet to become seriously ill or even die.

To provide medical attention as needed and to keep all immunizations current and updated according to a veterinarian’s schedule

To keep the Pet primarily indoors, interacting with my family, and not to banish it to the outdoors. I will never tie the Pet to a chain or rope or leave him/her unattended for long periods. The Pet will be exercised in a fenced yard or on a leash and will not be allowed to roam the streets.

To provide the pet a good quality dog food and water on a daily basis

To have the dog groomed a minimum of 6 times a year

To give unconditional love through sickness and health and especially in old age

That the Pet SHALL NOT be physically altered in any manner (docking tails, cropping ears, de clawing, etc.).

That I hereby give my permission for any veterinarian providing service to me to release medical information on any/all of my animals to Gulf Coast Cocker Spaniel Rescue ("GCCSR"), and give my permission to GCCSR to release my address and phone number to their veterinarian upon completion of any adoption for purposes of annual vaccination reminders.

To comply with all state and local ordinances in the confinement, care, and licensing of this Pet. I will reclaim this Pet promptly, and pay any required fees, if it is picked up by an animal control agency. IF THIS PET IS EVER STOLEN OR LOST, ADOPTER AGREES THAT HE/SHE WILL TAKE ALL REASONABLE STEPS TO FIND THE PET AND WILL IMMEDIATELY NOTIFY GULF COAST COCKER SPANIEL RESCUE. SUCH REASONABLE STEPS, INCLUDE, BUT ARE LIMITED TO, POSTING SIGNS IN THE VICINITY OF WHERE THE PET WENT MISSING AND CHECKING AREA POUNDS AND SHELTERS. IN THE EVENT THAT GULF COAST COCKER SPANIEL RESCUE OR ANY OF ITS AGENTS OR REPRESENTATIVES HAVE TO RETREIVE THE DOG FROM ANY POUND, SHELTER, OR PERSON THAT IS IN POSSESSION OF THE PET AFTER ADOPTER HAS BEEN NOTIFIED, ADOPTER AGREES TO IMMEDIATELY REIMBURSE GULF COAST COCKER SPANIEL RESCUE OR ITS AGENTS OR REPRESENTATIVES FOR ANY AMOUNTS EXPENDED IN PROCURING THE PET’S SAFE RETURN, AND GCCSR RESERVES THE RIGHT IN ITS SOLE AND ABSOLUTE DISCRETION TO DETERMINE WHETHER THE DOG SHALL BE RETURNED TO ADOPTER OR RETAINED BY US.

To keep Rabies and ID tags on the pet at all times, including the GCCSR Rescue Tag and personal ID tag of your own. If the dog is running loose, picked up by Animal Control or a good samaritan, and GCCSR is contacted, we reserve the right to refuse to return the dog to you.

THAT GULF COAST COCKER SPANIEL RESCUE DOES NOT MAKE ANY GUARANTEES REGARDING THE AGE, NATURE, TEMPERAMENT, OR HEALTH OF THIS PET. Adopter assumes all risks and responsibility including the financial responsibility of ownership of this Pet once he/she is in my possession and that Gulf Coast Cocker Spaniel Rescue is not in any way responsible for such costs incurred.

That if I fail to fully and timely comply with the terms of this contract, I will, voluntarily, immediately release ownership, possession, custody and control of this Pet to, Gulf Coast Cocker Rescue and if I fail to do so, Gulf Coast Cocker Spaniel Rescue will be entitled to enforce specific performance of this contract in addition to any other legal remedy available to Gulf Coast Cocker Spaniel Rescue

That all information in the Adoption Application is true, complete, and correct and agree that any false or misleading statement thereon will constitute a breach of this contract. If any information contained on Adopter's Adoption Application is untrue, Adopter expressly agrees that GCCSR may retake custody of pet without refunding adoption fee and without recourse by Adopter, and Adopter agrees to relinquish the Pet to GCCSR

That the breach by Adopter of this Agreement would damage Gulf Coast Cocker Rescue in a way that could not be adequately compensated by monetary damages. The parties therefore agree that the breach or threatened breach by Adopter of this Agreement may appropriately be restrained by an injunctive order for Adopter to return Pet to Gulf Coast Cocker Spaniel Rescue, granted by a court of appropriate jurisdiction. Adopter further agrees that the actual damages that might be sustained by Gulf Coast Cocker Spaniel Rescue by reason of the breach by Adopter of this Agreement are uncertain and would be difficult of ascertainment, and that, in addition to the injunctive relief agreed to above, the sum of $800 would be reasonable compensation for such monetary damages and attorney's fees. Adopter hereby promises to pay and Gulf Coast Cocker Spaniel Rescue hereby agrees to accept, such sum as liquidated damages, and not as a penalty, in the event of such breach.

That this Agreement shall be governed and construed in accordance with the laws of the State of Texas

That any disputes between the parties to this Agreement concerning the subject matter of this Agreement shall be submitted for resolution to the courts of Harris County, Texas.

I am at least 21 years of age.

Special provisions of this contract, if any, are as follows:

My Signature below confirms that I have read and agree to all above conditions:

Date

For Rescue Use Only

Name of Pet

Adoption Fee Received

CashCheckPayPal

Amount of Fee:

Accepted by GCCSR

Medical Records Delivered:

Heartworm Preventative Due on: