Adoption Application Form

COCKER SPANIEL RESCUE AUSTRALIA (under the umbrella of English Cocker Spaniels Australia Incorporated)

ABN: 57 202 992 447, Registered Charity with the ACNC, CCP 3163

Postal Address: PO Box 293 GLENSIDE SA 5065

www.csra.org.au

https://www.facebook.com/CockerSpanielRescueAustralia/

Cocker Adoption Application Form

Please provide answers to all questions, failure to do so may result in your application being rejected.

All applications will be acknowledged via text & email, please ensure that you check your Spam/Junk folder

Please note, all applicants must be over the age of 18 years

I confirm that I am over the age of 18 years.

ARE YOU APPLYING TO ADOPT A PARTICULAR COCKER SPANIEL?

If so, please provide the name of the Cocker Spaniel

I confirm that I have read and understood the full biography of the Cocker Spaniel I am applying for and that I comply with all the requirements.

IF NOT, PLEASE CONTINUE TO ‘PERSONAL DETAILS’

PERSONAL DETAILS

Surname

Given Name

Street Address:

Suburb

Postcode

State

Mobile

Home Phone

Identification: (Drivers licence or Passport will need to be sighted)

PEOPLE LIVING AT THE PREMISES

How many adults?

How many children?

How old are the children?

If you do not have children living at your premises, but do have children that visit you (i.e. grandchildren, nieces/nephews, friends), could you please advise their ages.

How old are the children that visit you?

WHAT TYPE OF PROPERTY DO YOU LIVE IN?

Please select: Required

House (single storey)

House (two storey)

Apartment − if multiple floors, please state which floor you’re located on. If you have a balcony, is it secure and safe for a dog?

Unit (single storey)

Do you own or rent your property? Required

Own

Rent

If renting the property, please supply the contact details for your Property Manager/Landlord (this includes their name, the name of the Real Estate Agency (if applicable), an email address and a mobile telephone number/landline telephone number). It is not sufficient to say you have permission, we must make contact with them to ensure that you do have permission and that it is noted on your lease/tenancy agreement.

Name of Property Manager:

Mobile Number:

Real Estate Agency:

Email Address:

OUTSIDE AREA

Do you have a fenced backyard?

Is it secure?

Approximately what size is it?

What is the height of your fencing at its lowest point?

HOME CHECK

Where possible we conduct home checks for the purpose of ensuring that the environment is secure, safe and suitable for a Cocker Spaniel to be kept in. If during the process of checking a potential adopter’s home it is found to be unsuitable, Cocker Spaniel Rescue Australia (CSRA) are happy to work with applicants to address the issues. If a physical home check is not possible CSRA must be provided (if requested) with photographs of your home and yard.

QUESTIONNAIRE

We ask all potential adopters to complete a questionnaire so that we can find out more about you, your family and your circumstances. This ensures that the right Cocker Spaniel is placed with you.

Please tell us why you want to adopt a Cocker Spaniel?

Have you owned Cocker Spaniels previously?

If not, have you undertaken any research on the breed?

Do you currently have any pets in your household? (If so, please list their type, sex, and age).

Do any of your current pets have any behavioural or socialisation problems? If so, please explain.

Are all of your current dogs/cats desexed, microchipped and registered with your local Council/Shire? If no, please give reasons why.

Are all your current dogs/cats in your household up to date with their vaccinations?

Will you continue to vaccinate the adopted Cocker Spaniel?

If your answer to the above question is no, please explain why (i.e. dog has autoimmune disease and cannot be vaccinated)

Will the Cocker Spaniel be an inside or outside dog? CSRA does not adopt to outside only homes.

Where would the Cocker Spaniel be sleeping?

What are your working circumstances? How long would the Cocker Spaniel be alone each day?

Do you have a doggy door installed in your home?

What would you do if your Cocker Spaniel developed behavioural issues?

Have you ever been refused an adoption with any breeder, other rescue group or shelter? If so, please explain:

Have you ever surrendered an animal to a shelter or released an animal to another party? If so, please explain:

REFERENCES

If you currently have a veterinary clinic that you attend, could you please provide the contact details (this must include the name of the veterinary surgery/clinic/hospital, their telephone number and an email address). Please make contact with your current veterinary clinic and advise them that you have submitted an adoption form to CSRA and that CSRA will be in contact with them for a reference (ask if they could note it on your records, please). If the veterinary records for your pet are NOT in your name, or if you haven’t been to your veterinarian in 3 or more years, please do not provide their details. Remember we will be seeking a reference about YOU, as a pet owner, not the health status of your pet.

Name of your current Veterinary Clinic/Surgery/Hospital

Telephone Number

Email Address

A reference from your current veterinary clinic is much preferred, however if you do not have a current veterinarian that you see, please provide the name of a person (a personal referee) who knows you extremely well, and has visited you at your residence and can vouch for you as a suitable person to adopt a Cocker Spaniel. Contact details must include their name, mobile telephone number and their email address. Please ensure that you have made contact with them to seek their approval to act as a personal referee for you.

Name of personal referee:

Mobile Telephone Number:

Email Address

IF YOU WERE TO BE SELECTED

Prior to you taking the Cocker Spaniel home, you must confirm that you, and all the members of the family including any dog(s) who currently live in the home, are willing to come and meet the Cocker Spaniel prior to adoption.

I confirm that all members of the family (including any dog(s) currently living in the home) will attend the meet and greet.

If the meet and greet goes well and you wish to take the Cocker Spaniel home with you, the adoption fee must be paid in full on the day. The Cocker Spaniel will NOT be released until evidence of bank transfer has been provided to Cocker Spaniel Rescue Australia.

If you would prefer to collect the Cocker Spaniel at a later date, the date/time/place must be agreed to with the foster carer. The adoption paperwork will be emailed to you once you indicate that you wish to adopt the Cocker Spaniel. And again, payment must be received in full prior to you collecting the Cocker Spaniel. Ownership will not be transferred to you until payment is received.

Please review your application to ensure that you have answered every question,
failure to do so may result in your application being rejected.

All applications will be acknowledged via text & email,

please ensure that you check your spam/junk file

THIS FORM CONSTITUTES A LEGAL AGREEMENT:
Before you submit it please read this carefully:

By submitting this Adoption Application Form, I agree that all the information I have provided is correct. Providing untruthful answers or failure to comply with the requirements of this application can result in the rejection of the application. If said information is found to be misleading or untrue after the adoption has taken place, I agree that the Cocker Spaniel will be returned to Cocker Spaniel Rescue Australia (under the umbrella of English Cocker Spaniels Australia Incorporated) immediately.

By signing and submitting this form, I agree to the following:
● I agree that the Cocker Spaniel will not be an outside only dog;
● I agree that the Cocker Spaniel will not be used for breeding;
● I agree to allow CSRA to check the references that I have provided;
● I agree to return the Cocker Spaniel to CSRA should the adoption not work out, or should my circumstances change in the future, or for any other reason that I am unable to keep him/her. I will not re-home the Cocker Spaniel myself. I will not surrender the Cocker Spaniel to another rescue group or shelter. I understand that my adoption fee will only be refunded to me if the Cocker Spaniel is returned to CSRA within seven (7) days of the adoption.

All Cocker Spaniels rehomed by CSRA will be desexed prior to adoption, except under special circumstances. By signing this Adoption Application Form, I agree to have the Cocker Spaniel desexed within seven (7) days of the adoption and I agree to provide proof of the desexing to CSRA. If for any reason this is not possible, CSRA is to be contacted and other arrangements will be made. I understand that ownership of the Cocker Spaniel
will not be transferred to me until proof of desexing is provided to CSRA. I also understand that ownership will not be transferred to me until the adoption fee is paid in full and the adoption papers have been signed and returned to CSRA.

We appreciate you taking the time to complete this application. Upon review and approval, we will contact you.

Cocker Spaniel Rescue Australia (under the umbrella of English Cocker Spaniels Australia Inc) reserves the right to refuse any application without prejudice or explanation.

I agree to the terms & conditions

Signed (Applicants name printed)

Date

Signed (Cocker Spaniel Rescue Australia)