Adoption Application Form
Name
*
Name is required.
Spouse/Partner Name
Address
*
Address is required.
City
*
City is required.
State
*
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[[uState.name]]
State is required.
Zip
Zip code must be 5 digits
Primary Phone
*
Primary Phone is required.
Invalid phone number
Invalid phone number
Secondary Phone
Invalid phone number
Invalid phone number
Email Address
*
Email Address is required.
This is not a valid email.
Occupation
Spouse/Partner Occupation
Best time to Call
What type of residence do you live in?
House
Condo
Townhome
Apartment
Other
Do you own or rent?
Own
Rent
If you rent do you have landlord permission to keep a dog?
Yes
No
Not Applicable
Landlord Name
Landlord Phone
Years at current address
If less than a year, previous address
Do you have a securely fenced yard?
Yes
No
What type of fencing?
Wood
Metal
Electric
Block Wall
Other
If no, how will you handle toilet duties?
If there are other adults in the home besides you and your spouse/partner, please list their names and their relationship to you.
How many children are living in your home?
Age and sex of children
Have you owned a Cavalier before?
Yes
No
If not, how did you hear about this breed?
If yes, from whom or where was your Cavalier from?
Do you currently own Cavaliers or dogs of other breeds?
Yes
No
If yes, list the breed, sex and age:
Does your dog(s) have any current behavioral issues?
Yes
No
If yes, please describe the issues and how they are being managed.
What type and brand of food is your current dog(s) eating? Or, if you do not currently have a dog, what type and brand of food do /you plan to feed your new dog?
Are dogs allowed on the furniture in your home?
Yes
No
Comments
Do you walk your current dog with or without a leash?
With Leash
Without Leash
Do not walk the dog
Have you ever owned a Cavalier or a dog of another breed?
Yes
No
Please tell us about your history of ownership with dogs. For each dog, list the breed/breed mix, how long you had the dog, and the cause of death or rehoming of each dog.
Have you ever given a pet away to another person, or to a shelter or rescue group?
Yes
No
If yes, please outline the circumstances:
Do you own cats?
Yes
No
If yes, how many and for how long?
Do you own pets other than cats or dogs (birds, rabbits)?
Yes
No
If yes, what, how many and for how long?
Where will the Cavalier spend the day?
Where will the Cavalier spend the night?
In general, what is your family's typical schedule?
On average, how many hours a day will the Cavalier be home alone without an adult over the age of 21 present?
If you are traveling, for example, going on vacation, what arrangements do you plan to make for the care of your dog?
Do you have a regular Veterinarian?
Yes
No
Veterinarian Name, Address and Phone
I give permission to call my Veterinarian for a reference
Yes
No
What are your reasons for wanting a Cavalier and for applying to rescue a Cavalier?
Desired Gender
Male
Female
Either
Desired Age
Puppy
Under 2 years
Under 5 years
Under 10 years
Any Age
Would you interested in adopting a pair of Cavaliers?
Yes
No
Maybe
Would you consider a senior Cavalier (ages 10 and up)?
Yes
No
Maybe
Would you potentially be interested in adopting a Cavalier who required ongoing medication or who had special needs?
Yes
No
Maybe
Would you be interested in adopting a Cavalier mixed breed?
Yes
No
Maybe
Are you willing to adopt a dog who is not aggressive, but who is shy or fearful and requiring extra socialization?
Yes
No
Maybe
Would you be willing to let a representative of the Cavalier rescue organization visit your home by appointment?
Yes
No
Do you agree to contact Cavalier Rescue USA if you can no longer keep or care for this Cavalier?
Yes
No
Are you applying to adopt a specific Cavalier? If yes, please list the dog's name and city/state below. Also, very important, please contact the person listed on the dog's page so they know of your interest.
What else would you like us to know about you and your family that would help us to make a good match, and assist us in determining if you'd be a great home for a rescued Cavalier?
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Alert!
All of the information I have given above is true and correct. I understand that if any of my responses above are not true, that Cavalier Rescue USA reserves the right to confiscate any dog they have adopted to me. Should I adopt a dog from this organization. I agree to provide the dog with proper and sufficient food, water, shelter, training, medical care, companionship and humane treatment at all times. I further agree that Cavalier Rescue USA (aka CKCSCR Inc.) is in no way liable or responsible for any damage, accident or injury resulting from the placement of a dog into my household.
We reserve the right to refuse any person or persons from fostering or adopting a dog from our organization.