EmailMe Form - Second CHANCE Cocker Rescue Application

Second CHANCE Cocker Rescue Application *

Name *

First Last

Email *

Phone *

### - ### - ####

Address *

Street Address City State / Province / Region Postal / Zip Code

How did you hear about us? *

If Other (how you found us), please state:

Specific dog(s) you are interested in? *

Reason for wanting a cocker? *

What are you looking for in a dog? check all that apply. *

What age range are you looking for in a dog? *

Do you have any other pets? or had any in the past? What happened to them? *

What is your lifestyle like? *

How many family members are there and what are the ages of the children? *

Is there anyone home during the day? *

How long will the dog be left alone on average? *

Where will the dog sleep? *

Where will the dog be when you are not at home? *

What brand of dog food are you planning on feeding? *

What kind of training are you planning to use on your dog? *

I would give up my dog because? Check all that apply. *

If Other (giving up dog), please describe why?

What type of home do you live in? *

I own/rent my home *

If Other (type of home and/or do not own/rent), please describe situation:

If you rent, please include your landlords name and contact info:

What is your $ limit for a major vet bill? *

Name and phone number of the Vet you plan to use *

Do you have a pool or spa? *

If so, is it fenced? Will the dog be allowed access unsupervised?

I understand there is an adoption fee of $250-400 depending on the age of the dog. *