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Name:
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Email Address:
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Address:
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City:
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State
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Zip:
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Home Phone:
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Alternate Phone:
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Your Occupation(s):
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Number & ages of children living in your household:
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What type of area do you live in?
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City
Suburb
Rural
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Type of Housing?
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House
Condo
Duplex
Other
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Do you own or rent?
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Own
Rent
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Do you have permission from your landlord to own a dog?
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Yes
No
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What other dogs have you previously owned, and what happened to them?
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What other pets live in your home?
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What do you know about English Springer Spaniels?
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How did you hear about us and who referred you?
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Dog preference-gender:
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No Preference
Male
Female
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Dog preference-color:
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No preference
Liver/White
Black/White
Tri
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Dog preference-type:
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No Preference
Field
Bench
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Would you consider sharing your heart with an older dog 8 years and older?
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Yes
No
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What is the age range you will consider?
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Will you consider a dog with special needs?
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Yes
No
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Would you consider a Springer Mix?
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Yes
No
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Would you consider adopting a pair?
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Yes
No
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Do you have a fenced in yard?
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Yes
No
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If you don't have a fence how will you excerise and keep your dog safe?
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What kind of activities will your Springer participate in?
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Will the dog be allowed on furniture?
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Yes
No
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Will the dog be allowed on the bed?
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Yes
No
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Do you plan to hunt with the dog?
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Yes
No
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Do you have a pool?
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Yes
No
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Do you have a dog run/kennel?
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Yes
No
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Does anyone in your household have allergies to pets?
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Yes
No
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Have you ever trained a dog in obedience classes?
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Yes
No
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Will you take your adopted Springer to an obedience class?
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Yes
No
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Will the dog live in your home?
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Yes
No
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Where will the dog sleep?
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Are you familiar with crates and their uses?
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Yes
No
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What types of activities, hobbies, or excercises do you and your family participate in?
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If you move, what will you do with your Springer?
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When you go on vacation, where will your dog go and who will care for him/her?
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Who is the veterinarian you will use? Provide all information, ie. Name, Address, and Phone number.
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Can we call your vet and ask about the care of your previous pets?
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Yes
No
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How will your dog travel to the Vet or other places? (In a car, crate, or the back of a pickup truck)
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Are you financially prepared for the routine expenses of owning a dog? Vaccines, heartworm prevention, parasite control, grooming, nutrition, training, etc?
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Are you willing to allow a NEESSR representative to visit your home?
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Yes
No
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Please tell us a little about yourself and why you would make a good home for an NEESSR rescue dog?
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