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

Fillable Form

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 rescued 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 of 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. Our adoption fee 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 each dog is estimated using our experience and the advice of our veterinarians. Oftentimes, 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 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 your application to adopt that particular DOG.

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

ADOPTION APPLICATION

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Your Email:

A Password:

Confirm Password:

Date of Application:

Name and Gender of Dog in which you are interested:

Part I Information About You and/or Your Family:

Applicant Name(s):

Street Address

City State and Zip

E Mail address:

Home Phone

Mobile Phone:

Work Phone

Spouse/Partner's Name:

Spouse/Partner's Work or Mobile Phone:

Your Employer:

How long have you been employed there?

What is your Occupation?

Name of nearest relative not residing with you, and their relationship to you:

Relative's Phone Number:

Are you over 21 years of age ?

Do you live alone or with other people ?

If you live with other people, what are their ages and relationship(s) to you ?

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 ?

If so, how old are they ?

Do they live in the household ?

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

Are there any other individuals who regularly visit the home, and if so, what are their ages?

Part II Consent to Release Veterinary Information

I hereby give permission for any veterinarian providing service to me to release medical information on any and all of my animals to a representative of GCCSR. Signed:

Please provide vet contact information for any living pets, or pets who passed in the past 10 years:

Veterinarian Name:

Clinic Name:

Phone Number:

Please click the “Add Additional Vet” link in the right hand corner of this section to add additional vet contacts for any current pets, or those who passed in the past 10 years.

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

Please provide information about any of your current pets, and/or any pets you have had in the past 10 years.

Name of Pet:

Breed:

Sex:

Spayed/Neutered?

Current on Vaccinations?

Current on Heartworm Preventative?

How and when did you get this pet?

Is the pet still living?

Does/did this pet have any behavioral problems or conditions?

If you no longer have this pet, what happened to him/her?

Where does/did your pet sleep?

Where does/did your pet stay while you are away at work?

Please click on the "Add More Pets" link below to add additional current pets, or those who passed in the past 10 years.

Part IV: Information About Your Home

Do you Own or Rent Your Home ?

Is it a house or an apartment/condo?

If renting, how long have you been at this location?

If renting, does your lease allow pets ?

Are there any breed or weight restrictions ?

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

Manager/Owner's Phone Number

Do you have a fenced yard ?

What type of fence is it and how tall is it?

Part V: Information About Leaving/Housetraining/Exercising/Obedience Training for Pet

How long will the pet be left alone each day ?

Where will the pet stay when you are gone?

Do you or other adults in the house 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 and how often?

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

Where would the pet sleep ?

Part VI: 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 an animal?

If so, why ?

If so, what did you do with the animal?

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 check on the pet?

Part VII: 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/thousands of dollars)

What would you consider a major medical expense you could not afford? ($100, $500, $1,000, $2,500+)?

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?

By printing my name below, I agree that all information provided in this application is true, complete and correct.

Applicant Printed Name

Co-Applicant Printed Name

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