applic.htm

YOU MUST COMPLETE EACH QUESTION ON THIS APPLICATION. INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED. PLEASE ANSWER EACH QUESTION IN AS MUCH DETAIL AS POSSIBLE, PROVIDING PHONE NUMBERS AND APPROPRIATE CONTACT PERSONS AS REQUESTED.

CUT AND/OR COPY, AND PASTE IN AN E-MAIL OR AN ATTACHMENT, OR SEND A FAX AT THE APPROPRIATE NUMBER ABOVE.

Name of Dog(s) You Wish to Adopt: ______________________

____________________________________________________

Applicant Name: ______________________________________

Address: ____________________________________________

____________________________________________________

Home Phone: ________________________________________

Work Phone: _________________________________________

Cell Phone: __________________________________________

E-Mail Address: ______________________________________

How did you find out about CSAC?
Why do you want to adopt a dog?
What do you think are the most important responsibilities in owning a dog?
Why do you want to adopt a Cocker Spaniel in particular?
How long has it taken you to decide to adopt a Cocker Spaniel?
Are you willing to take the time to work with a dog on housebreaking issues, should the need arise? __yes __no
Do you understand and accept that changing a dog's environment may cause the dog to have accidents, especially in the early days of the adoption? __yes __no
If a behavioral problem arises, what steps will you take to work on it?
Does any member of the family have any allergies to animals? __yes __no
If yes, please explain:
For whom are you adopting the dog? __self __gift
Have you ever owned a pet before? __yes __no
If yes, what kinds of animal(s) and when?
Which of these pets do you still own?
Please describe any pets you still own, in as much detail as possible (type, age, sex, etc.).
Is/are the animal(s) spayed/neutered? __yes __no
Which pets do you no longer own?
What happened to him/her/them?
Were they spayed/neutered? __yes __no
Have you ever given any of your animals away for any reason?
___yes ___no

If yes, please explain the reason(s):
What do you consider a good and valid reason for giving up a dog?
What is the name and phone number of the veterinary hospital where your animal(s) has/have received care and vaccinations?
Do you have a different vet in mind for your new pet? __yes __no
If yes, please specify, and kindly say why you are changing vets.
What kind of veterinary care do you intend to provide?
Have you done or do you intend to do any reading in preparation for a new dog? Please specify:
Will you consider obedience training for your dog? __yes __no
Do you have any experience with obedience training? If so, please specify:
Would you be willing to obtain a crate if recommended for the dog? __yes __no
How many people currently reside in your household?
Is everyone equally enthusiastic about adopting a dog?
____yes ____no Please explain your answer:
How would you describe the activity level in your household?
Are there any children in the home? __yes __no
If yes, what are their ages?
If there are children in the home, do any have experience with animals? ____yes ____no
If yes, please provide some details:
Do children visit your home regularly or occasionally?
____yes ____no
If yes, please explain:
Who will be responsible for feeding the dog and taking him/her outside?
In the absence of the primary caretaker, who will take care of the dog?
Do you own or rent your residence? __own __rent
If you rent, what is the name of the landlord and the phone number?

-- Are pets allowed? __yes __no
Do you live in a:

_____Single family home

_____Duplex

_____Townhouse

_____Mobile home

_____Condominium

_____Apartment

_____Other (please explain):
Are there any restrictions or covenants where you live?
___yes ___no

If yes, please list them:
Do you have a fenced yard? __yes __no
If yes, how high is the fence?

-- What type of fence is it?

-- Any holes or gaps or weak areas?

-- If you do not have a fence, do you plan to get one? __yes __no

-- If so, when?

--If not, why not?
Would you walk/exercise a dog on or off-leash or both?
Where will the dog be kept? __indoors only __outdoors only __both in/out (explain):
How much time will the dog spend outdoors?
Explain:
Will anyone be home during the day? __yes __no

-- How many hours will the dog be left unattended?
When you are home, where will the dog be kept?
When no one is home, where will the dog be kept?
Where will the dog sleep?
Are you willing to keep a collar with a tag bearing your name and phone number on your dog at all times?

___yes ___no
How often and for what reasons do you travel?
What will you do with the dog when you travel?
What will you do with the dog if you move/change housing?
Are you or your spouse with the military? __yes __no
Have you ever bred or raised dogs? ___yes ___no
Have you ever participated in dog shows? ___yes ___no
Please estimate the annual cost of the following:

-- Premium Food (Many Cockers have food allergies) $__________

-- Grooming (Every 6-8 weeks, minimum) $__________

-- Vet Care (including necessary shots, heartworm preventative , ear, eye and teeth maintenance) $__________

-- Extras (Toys, treats, beds, bowls, leash, collar, id tag) $__________
Are you able to comfortably provide the estimated care, and are you prepared for possible other costs, in addition to your estimation? (Examples: sickness, accidents, emergency care).
___yes ___no
Are you aware and do you accept that CSAC requires that all dogs and cats in the household be spayed/neutered before an adoption of a CSAC dog can take place? __yes __no
Are you aware and do you accept that CSAC requires a fee of $250 for dogs under the age of eight years and $200 for dogs eight years and older? __yes __no
The average Cocker Spaniel has a lifespan of 12 to 15 years. Are you willing to make a commitment to this dog for the rest of his/her life? __yes __no
Are you willing to provide the necessary love and attention, as well as the necessary food, vet care, and grooming required to maintain a happy, healthy Cocker Spaniel? __yes __no
If this is a long distance adoption, are you willing to:
__Travel to get the dog (by plane or car or both?)
__Pay for the costs of transportation.
__Meet somewhere along the way.
__Unable/Unwilling to travel or assume costs.
Have you reviewed and do you understand and accept the CSAC adoption contract? __yes __no
If, for any reason, you are unable to keep your dog, do you agree to notify CSAC immediately? ___yes ___no
If you are unable to keep your dog, do you agree to return him/her to CSAC without hesitation? ___yes ___no
If this is a long distance adoption, and you are unable to keep your dog, are you willing to assume the responsibility, including travel and financial responsibility, for returning the dog to CSAC? ___yes ___no
Please list any preferences you have in adopting a dog (age, sex, breed, personality, etc.):
Please provide the names and numbers of two people we may contact to serve as references for you. This could be your vet or vet staff members or anyone who knows you, especially with respect to your interaction with animals.
Please list any concerns or final questions here:

I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand and accept that CSAC has the right to annul the adoption and reclaim the dog.

I give CSAC permission to fully investigate the information provided as well as contact veterinarians and related officials. If the application passes this review, I agree to a home and yard visit on a mutually agreed date by a CSAC representative before an adoption decision is made.

Furthermore, I understand and accept that the adoption decision depends upon many factors, including – but not limited to – the compatibility of the family and home to the individual dog and other applications received on the dog. I understand and accept that it is CSAC's prerogative to decide which home is most appropriate for the individual dog, and therefore I will not take issue with the decision. Unless otherwise indicated by CSAC, I may be considered for another dog.

Signature:

_________________________________________

Printed Full Name:

_________________________________________

Date: _____________________________________