Adoption Application

Mid-South Cocker Spaniel Rescue is a volunteer organization dedicated to rescuing cocker spaniels that find themselves in kill-shelters.  As such, the organization relies on donations and adoption fees in order to operate.  The adoption fee for our cocker spaniels is $200.All monies received by Mid-South Cocker Spaniel Rescue are used to pay the expenses of pulling the dogs from shelters, vetting/altering them, and providing daily care for them, until they find forever homes of their own.

 

First Name:

Last Name:

Home Phone: (xxx)xxx-xxxx

Work Phone: (xxx)xxx-xxxx

Mobile Phone: (xxx)xxx-xxxx

Fax Number: (xxx)xxx-xxxx

Street Address:

City:

State:

Zip Code:

Email Address:

Why do you want a pet? Companionship Family Pet Working Animal Other?

If there is a particular pet shown on our website that you would like to learn more about, please list their name(s):

How did you hear about Mid-South Cocker Spaniel Rescue?

Do you want a Male, Female, or Either?

If no one is home during the day, what will you do with your pet?

Where will your pet sleep at night?

What will you do with your pet while you are out of town on business or vacation?

 

What will you do with your pet if you have to move?

Have you ever owned a pet? Yes No

If the answer is yes, and you no longer have the pet, please tell us how long you owned your pet and what happened to the pet.

Do you currently have pets? Yes No

If you answered yes, please tell us about them including type, age, disposition (such as whether they would get along with another pet) and if they are spayed or neutered.

Please list the people in your household and their ages.

Does anyone in your household not want a new pet? Yes No

Do you: Own your home Rent Other

If other, please explain.

If you rent, do you have permission from your landlord to have a pet? Yes  No

Please provide your landlord's name and phone number for confirmation.

Is your yard fenced securely? Yes No

Do you have a pool? Yes No

How do you plan to ensure your pet's safety outdoors?

What will you do if this pet has behavior problems, such as not being housebroken, barking too much, chewing, or demanding a lot of attention?

List medical care you would provide and how often you would provide it.

What will you do if this pet becomes ill or injured and requires expensive medical care?

What will you do if this pet becomes lost?

Do you currently have a vet? Yes  No

If yes, please provide the vet's name, location, and phone number.

May we contact this vet for a reference? Yes No

If you do not have a vet reference, please provide name and phone number of three personal references.

Reference 1:

Reference 2:

Reference 3:

 

Mid-South Cocker Spaniel Rescue thanks you for your interest in adopting a rescued cocker spaniel.  Adoption decisions are made by considering the best interests of the dogs being placed and are at the sole discretion of Mid-South Cocker Spaniel Rescue.  Our goal is to find the family and home that is the best fit for each dog we rescue.  Please understand that our decision to place a dog with one applicant does not necessarily reflect on the qualifications of other applications.