First Name*
Last Name*
Address
City
State/Province
Zip/Postal Code -
Email*
Home Phone
Work Phone x
Cell Phone
Alt Email
Address*
City State Zip *
Phone Home:*
Phone Cell:*
Phone Work:*
Best time to call*
Occupation*
Please list all household members and ages for everyone in the house. * Listing ages is a REQUIREMENT, if this is skipped your application will not be processed* *
If you rent a home or live in a condo, does your contract allow you to have a dog?*
Does anyone living in your home have allergies to dogs?*
Who will be assuming the responsibility of this dog?*
Do you have the financial means to care for this dog's vet care and food?*
Does everyone listed want a cocker?*
Will the cat be kept indoors or outdoors, or will you allow it to do both?*
Have you ever owned a cocker before?*
Do you have a fenced yard?*
Please list all the pets you currently own and if they are spayed or neutered, up to date on vaccinations, and on heartworm preventative.*
Please explain how you will introduce your new dog to your current pets.*
Have you ever given up a dog? If yes, please explain the situation.*
What happened to your last dog?*
Please list the activites you plan to share with your dog (hiking, running, walks, training, etc)*
Will your dog have the run of the house?*
If he/she does not have the run of the house, where will he/she be restricted?*
Will he/she have a dog bed/cushion?*
Where do your pets sleep?*
How long are your pets left home alone (per day)?*
Are you familiar with using a dog crate?*
Where will your dog stay when you go on vacation?*
If behavior problems should arise, how would you handle them?*
Please list your veterinarian's name, address, and phone number*
Please list any special stories or comments you would like us to know about *
Which animal are you interested in* Choose an animal: Molly Willow
Please describe why you and your family would be a perfect match for this individual dogs needs and how you plan to fulfill them. Also, why would would like this dog. *
