Betsy's Cocker Place

Adoption Application

 
Your Information
* Your Name and Spouse
* Street Address
* City/State/Zip
* E-Mail Address
* Home Phone     Work Phone   Cell Phone
* Your Occupation
* Your Employer
* Spouse/Partner Occupation
* Spouse/Partner Employer
* How Long Employed
* How Long Spouse Employed
Your References
* Personal Reference 1
* Street Address
* City/State/Zip
* Phone Number
   
* Personal Reference 2
* Street Address
* City/State/Zip
* Phone Number
   
* Your Veterinarian (where your pet's records are kept)
* Vet's Phone Number
* Vet's Address
* Vet's City, State, Zip
* Vet's E-Mail Address
* Vet's Fax Number

* Describe the type of cocker You prefer to adopt. If a specific cocker, please state their name.  Please be as specific as possible:

 
* Would You prefer a male or a female cocker?

Male Female Either

* Please describe the qualities most important to You:

* What issues are You NOT willing to deal with? (Please check all that apply) Dog to Dog Aggression  Not Good with Small Children Separation Anxiety Over-protectiveness House Training Problems Excessive Barking Chewing (dogs)  Shyness None Other
If Other, please explain:
General Living Situation
* Do you live in: House Apartment Other
If Other, please explain:
* Do you own or rent your home? Own Rent
Renter's Information
What does your lease state about keeping pets?
[Restrictions, deposits, size or breed limitations, etc]
Landlord's Name
Street Address
City/State/Zip
Phone Number
Household Information
* How many live in adults?   * Do you have children? Yes No
If children, please specify how many and their ages:
* Do you now - or did you ever - have any other pets? Yes No

Your Pet History (Please list all pets you've owned in the last 5 years)
Name Breed Age Sex S/N¹ Where Obtained? Where Now?
¹ S/N = Spayed or Neutered - Please indicate Y for Yes or N for No
* Do you have a 'pet door'? Yes No
* Do you have a fenced in yard? Yes No
If yes, please specify height of fence:
* Is anyone in your household allergic to pets? Yes No
* Do you run a Daycare in your home? Yes No
* Which family members will be responsible for your dog?
* Where will dog be kept when you are not home?
If Other, please explain in detail:
* How many hours per day will your pet spend alone?
* Where will your pet sleep?
Additional Information
* Have you ever surrendered a pet to Anyone? Yes No
If yes, please explain in detail:
* Are you now or have you ever been a breeder? Yes No
* What brand of heartworm/flea meds are/were your pets on?
* Do you keep your dogs current on all vaccinations/check ups?

Yes No
* If you move in the future, what will you do with your pet(s)?
* If you go on vacation, what do you do with your pet(s)?
* What form of discipline do you use on your pet?
* What are your feelings about pet obedience training?
Do you take them to training classes? Yes No
* What are your feelings about crate training?
* How will you deal with a housebreaking accident while you are home?
* What about if it happens when you are not at home?
* What if pet chews or scratches something inappropriate?
* How do you feel about us checking up your pet?
* What are some of the things you enjoy most about having a pet?
Additional Comments:
For what reasons would you surrender a pet for rehoming?
* How did you find out about Betsy's Cocker Place?
If Other, please explain how you heard about us:
Electronic Signature
Your electronic signature below serves as acknowledgement that this is a sincere inquiry, and that all information provided is true, correct and complete.  On the Internet an Electronic Signature carries the same legal weight as if you were signing your name to a printed document. To complete this form, please provide your electronic signature below by typing your name in the box, then submit the form.
Signature:

If there is any further information you would like to include, please send it to us in an e-mail.

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