Cocker Spaniel Rescue
of East Texas

P.O. Box 28
Sugar Land, TX 77487-0028
Voice: (713)208-1314


Home Checks Are Done Before Placement
You MUST read the Adoption Contract
and agree to its terms and conditions
before your application will be considered.

You will be required to sign this agreement
when you take possession of the dog.


I have read the Adoption Contract and I agree to its terms.
Click this box if you agree =>

Select the type of application

Applicant Information

First Name: Last Name:
Spouse or Partner's Full Name:
Names and ages of all persons residing in your home, including yourself:

Home Address:
City: State: Zip Code:
email address: Home Phone: Cell Phone:

Employer (if retired, provide last employment):
How Long?: Occupation:
Address: Work Phone:
Spouse Employer (if retired, provide last employment):
Address: Work Phone:
How Long?: Occupation:

Own or Rent home? Own Rent House Rent Apartment     How long have your lived there?:
If Renting: Is Pet Deposit Required? Yes No                 Is there a size limitation? Yes No
Name and Phone Number of Manager/Landlord: Phone:
Do you have permission from the Manager/Landlord to have pets? Yes No

Fenced Yard? Yes No            Is a swimming pool, spa or other body of water present? Yes No

Name of nearest relative not residing with you:
Address:      Phone:

Have you adopted, purchased or otherwise acquired any animals in the past year? Yes No
If yes, please elaborate:
Have you applied within the past year to any other public or private animal adoption agency or rescue group? Yes No
If yes, which ones?:

Information on Current Pets

List the type, breed, age and sex of all pets currently owned.

Where does your present dog spend most of its time when you are home?
Inside Outside Other
Where does your present dog stay when no one is home?
Outside Loose Inside House Crated Inside House Other
Are all dogs and cats spayed or neutered? Yes No   If No, Why?
Are all dogs and cats on heartworm preventative? Yes No   What brand?
Are their medical records/vaccinations current for:   Parvo Yes No Don't Know      
Bordatello Yes No Don't Know               Distemper Yes No Don't Know
      Lepto Yes No Don't Know               Rabies Yes No Don't Know

What other dogs and/or cats have you owned in the past 15 years, and what happened to them?

Veterinarian's Name         Phone:
Veterinarian Clinic Name:
Veterinarian Clinic Address:

Life with a Cocker Spaniel

Which Cocker Kid(s) caught your interest?

Why do you want a cocker spaniel?


Have you ever had a Cocker Spaniel before? Yes No
If Yes, What happened to it / them?
Is this Cocker Spaniel a gift for someone? Yes No
Is everyone in your household aware and agreeable to adopting a Cocker Spaniel? Yes No
Are you financially capable of taking care of an ill or injured pet? (This can cost hundreds of dollars) Yes No
Where will you keep your pet during the day?
      during the night?
What will you feed your Cocker Spaniel?
Where will you have your Cocker Spaniel groomed?
      How often?
How many hours a day will your pet be without human companionship?
What will you do with your pet if you move?
If you leave town, who will care for your pets?
Who will take care of your animal if something happens to you?
Is anyone in your household allergic to dogs? Yes No
      if yes, please elaborate: