Camp Cocker
Adoption Application

Name:
Email Address:
Home Phone:
Cell Phone:
Street Address:
City, State & Zip Code
Occupation
Place of Employment:
Work Phone:
Number of adults in home:
Number of children in home:
Age of children (if applies)
Type of home:
Do you:	Own (copy of property tax bill required) Rent (landlord's approval is required)
Landlord's Name (If Applies):
Landlord's Address (If Applies):
Landlord's Phone Number (If Applies):
How many dogs are allowed? (If applies):
What characteristics would you hope for in your new dog? (personality, color, gender, age range, etc.)
What characteristics would you wish to avoid in your new dog?
Check the following box regarding the behaviour that you would not tolerate.	Getting on Furniture Chewing Jumping Barking Potty Accidents Crying/Whining Barking Begging Getting in Garbage Shredding Other
If you checked any of the above checkboxes, please explain how you would handle the situation.
Would you be willing to housetrain a dog if necessary?	Yes No
If there are problems with housetraining or other behavior, would you be willing to hire a professional trainer to help you?	Yes No
Do you have a fenced yard?	Yes No
If so, are the fence and gate in good repair and of a type that a small dog could not get out?	Yes No
Please describe the yard and fence in detail (including height and gaps):
Please describe all entrances/exits to your residence and if there is dog proofing to protect your dog from accidentally slipping out. If not, are you willing to install some type of dog proofing as a preventative safety measure?
Do you have a swimming pool?	Yes No
Is the pool fenced off from the rest of the yard? (If applies)	Yes No
Do you have a doggie door?	Yes No
If the dog is left outside when you are gone, will he/she have some sort of access into the house?	Yes No
What is your philosophy regarding dogs which develop medical problems and how would you deal with them?
The decision to own a dog can be an expensive lifestyle change. If your new dog were to accumulate significant medical expenses, what would be your personal monetary limit before considering euthanization or relinquishing the dog back to our rescue group.
Do you plan to get Pet Insurance? (to help pay for major medical emergencies)	Yes No
Cocker Spaniels are, as a breed, often subject to chronic ear infections. Would you be willing and able to handle the daily treatments yourself , as well as the sometimes frequent veterinary bills for these and any other illnesses?	Yes No
Cocker Spaniels are often genetically predisposed to eye problems, such as cataracts or glaucoma (even at a young age). Are you prepared for the medical expenses these problems may present? (Cataract Surgery can cost $2,000 per eye.)	Yes No
If not, please explain:
A healthy & happy dog requires regular exercise. Are you willing to provide that?	Yes No
Will the more frequent coat brushing (daily) and professional grooming needs (at least every 6 weeks) of this long-haired, long-eared, breed be a problem for you financially or otherwise?	Yes No
If your dog needed a special diet, would you be willing and able to provide it?	Yes No
How many hours a day will your dog be left alone?
How many days a week will your dog be left alone?
Where, specifically, will the dog be left when alone?
Where, specifically, will the dog sleep at night?
Who would care for your dog should you go out of town?
Are you willing to accept full care/costs & the responsibility of owning a dog that may have a lifespan of 14-18yrs?	Yes No
What would happen to your dog if it became necessary for you to move or if you became physically or financially unable to care for him/her?
What kind of food do you plan to feed your dog? (we can offer you guidelines on how to read pet food labels for nutrition)
Is this your first time owning a dog as an adult? If so, are you able & willing to hire the assistance of a dog trainer to help teach you the basics of animal handling & communication?
Do you own any other pets at the present time?	Yes No
If you have other animals in the house, do you understand that their may be an "adjustment" period, lasting a few weeks or more, where the animals may need direct supervision while they learn to settle in the new family.	Yes No
If so, please list the types of pets, what breeds they are, whether or not they have been spayed or neutered, and any other information you would like to tell us about them, including information about his/her personality:
If you have had other dogs in the past, please tell us why you no longer have each one. If they passed away, at what age and under what circumstances?
Would you consider this dog to become a member of your family and make every effort to be a loving guardian for the rest of his/her natural lifespan?	Yes No
How long do you expect it to take before you and your new dog bond with each other? (X weeks,months,days)
What is a reasonable timeframe for you that a dog should be able to adjust to its new home?
Have you ever had to give up a pet? If yes, please explain.
For what reason would you consider giving up your pet?
Cocker Spaniels should never wear shock collars and have been known to die of seizures from such devices. Do you agree to pursue other safer and more humane ways to modify unwanted behavior?	I agree I disagree
The dog must never be restricted only to the yard, patio or garage and must have access to the inside of your house, and he/she must never be tethered or chained up.	I agree I disagree
The dog must never be left alone tied up in public. There is an epidemic of dogs being stolen from outside of stores/coffee shops when the owners are only inside for a few minutes. The same guardianship measures should be taken like you would for a smal	I agree I disagree
He/she must also never be transported in the OPEN back end of a pickup vehicle.	I agree I disagree
Do you agree to allow post-adoption vists at mutually agreeable times?	Yes No
Please list one veterinarian reference with his/her phone number:
Plase list one groomer reference with his/her phone number:
If you do not yet have relationships with a veterinarian and a groomer, do you agree to establish these relationships and provide Camp Cocker with this information before adopting a dog?	Yes No
Please list 2 non-family references with their phone numbers:
Please tell us why you would like to add a dog to your home & add any additional comments you feel would help us better understand you and your home as a potential Cocker Spaniel family. And thank you for offering a rescue dog a loving home!!
Camp Cocker is a subsidiary of the rescue organization Katrina Dog Rescue. There will be a non-refundable donation of $275.00 - $500.00 required at the time of adoption.	I agree I disagree
Many of our rescued cockers have hefty medical bills and others do not. Averaged out, it costs about $750 per animal we rescue and rehabilitate. Your adoption donation is just a very small portion of what we need to continue with our rescue efforts to s	I would be interested in making a donation from time to time, please email me when you have a particularly needy dog I would be interested in making a monthly donation towards the boarding facility that Camp Cocker uses I am not able to offer future donations, but I can help by forwarding fund-raising emails to everyone I know I would like to offer my support by sending you positive wishes and lots of encouragement!
Our other requirements include a home check, an adoption contract to be signed at the time of adoption, and occasional post-adoption visits. This Adoption Application will also become part of the Adoption Contract. As such, do you verify that the informat	Yes No