Adoption Form

AMERICAN CAVALIER KING CHARLES SPANIEL RESCUE TRUST

PRELIMINARY RESCUE ADOPTION APPLICATION

Name:

Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Cell Phone:

E-Mail:

Please tell us why you want to adopt a Cavalier King Charles Spaniel:

Have you ever had this breed before?

Yes
No

If yes, is this Cavalier still residing with you?

Yes
No

If not, please explain:

How many animals presently reside in your household? Dogs Cats Birds Other animals (please describe)

Are all the dogs you currently own spayed or neutered?

Yes
No

Do you want a:

Male
Female
Either Sex is fine

Do you have a color preference?

Any color
Blenheim
Tri color
Ruby
Black and Tan

Other traits/characteristics that are important to you:

What behaviors can you NOT tolerate?

Keeping in mind that it is rare to get a puppy in rescue, what age would you consider?

1 year
5 years
Over 5 years
Over 8 years

Would you accept a dog that requires medications?

Yes
No

Would you accept a dog with a health condition?

Yes
No

Number of adults in family?

Number of children?

Ages?

Does anyone in the household have allergies?

Yes
No

How would you describe the activity level of your family?

High
Medium
Low

If there are children in the family, will they help with the care of the dog?

Yes
No

If so, in what capacity?

Do you:

Own your own home?
Rent?

My home is a:

House
Townhouse
Apartment
Condo
Duplex

Do you have a private yard?

yes
No

Is it fenced?

Yes
No

If so, type and height of fence:

Is your lawn/yard chemically treated?

Yes
No

How will the dog be exercised daily?

Please describe where would the rescue dog stay during the day?

Where would the rescue dog sleep during the night?

There is a period of adjustment for each rescue to its new surroundings, which may include potty accidents, chewing, digging, shyness, or other undesirable behaviors.

Are you aware of this period of adjustment?

Yes
No

If the rescue dog makes a "mistake", describe what kind of a correction you would make:

Would you be willing to take a rescue dog to training class if necessary?

Yes
No

Please list other rescue organizations, clubs, or shelters to which you have applied:

BY SUBMITTING THIS FORM, I AGREE THAT:

I understand that this is a preliminary rescue adoption application and that there may be no Cavalier King Charles Spaniel available in Rescue at this time. I understand that if a Cavalier should become available, that I will be required to complete a more detailed application. I further understand that my Preliminary Adoption Application will be kept on file and I will not be contacted unless an apropriate rescue becomes available.

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Rescue Trust

AMERICAN CAVALIER KING CHARLES SPANIEL RESCUE TRUST