Owner Information Form

The goal of Cocker Spaniel Rescue’s adoption program is to find a permanent, responsible and loving home for this dog. In order to help us find a suitable home for your cocker and to help us care for this pet while it is in foster care, we need some information about the dog, its habits and its personality. Please answer the following questions as completely as possible. Please also be prepared to provide any paperwork you might have (vet records, spay/neuter certificate, proof of shots, etc.). Thank you.

Dog's Name(Required)

Photo(s)

Please provide at least three close-up photos of your cocker spaniel (limit of 10).

Drop files here or

Accepted file types: jpg, jpeg, png, haic, pdf, Max. file size: 256 MB, Max. files: 10.

Sex(Required)

Female

Male

Color(Required)

Weight(Required)

Age(Required)

Date of Birth (if known)

Is your dog microchipped?(Required)

Yes

If yes, what is the chip number?(Required)

Name of registry(Required)

Has the dog been spayed or neutered?(Required)

Yes

If yes, when?(Required)

How long have you owned the dog?(Required)

Where did you obtain this dog (breeder, pet store, friend, stray, shelter, etc.)?(Required)

Name of breeder (if known)

How many homes has this dog had?(Required)

Why are you giving this dog up for adoption? Please include information that may help the new owner assist this dog in adjusting to a new home.(Required)

Is this dog housebroken? If not completely, how often, and under what circumstances does the dog have accidents?(Required)

Is this dog good with children of all ages?(Required)

Has this dog played with children?(Required)

Yes

If yes, what are the ages of the children?

Would you describe this as an "adult only" dog?(Required)

Does this dog accept strangers?(Required)

Yes

If not, please describe how the dog reacts to strangers(Required)

Does this dog prefer either men or women?(Required)

What things can upset this dog? What is the dog afraid of, or what, if anything, does the dog dislike?(Required)

How does the dog react to being left alone?(Required)

Do you know if this dog barks frequently if left alone?(Required)

Would you describe this dog as a barker?(Required)

Where is the dog left when you go away for the day/evening?(Required)

How long can the dog be left alone during the day?(Required)

Is the dog used to a regular 8-hour workday?(Required)

How long can the dog "hold it" before he/she might have an accident in the house?(Required)

Where does the dog sleep? State which room and whether he/she is confined to a crate or area in that room.(Required)

Has this dog been "crate trained"?(Required)

When the dog is outside, is he tied, fenced, on an overhead run, or running loose?(Required)

Does the dog like to ride in the car?(Required)

Yes

Does the dog like to swim?(Required)

Yes

Does the dog like other dogs?(Required)

Yes

Does the dog like cats?(Required)

Yes

How does the dog react to male dogs?(Required)

How does the dog react to female dogs?(Required)

How does the dog walk on a leash?(Required)

Has the dog had any formal obedience training?(Required)

Has the dog had any other special training?(Required)

What commands does the dog know?(Required)

What brand of food does the dog eat?

How often and how much do you feed the dog?(Required)

Medical Information

What medical conditions has this dog been treated for? Please give approximate dates.(Required)

Is the dog on any medication?(Required)

When was the dog last seen by a vet?(Required)

Is the dog up to date on DHLPP, rabies, and heartworm test?(Required)

Yes

When were these shots last given?(Required)

Was the dog on heartworm preventative (daily or monthly) during last spring, summer, and fall?(Required)

Yes

Is your current pet on heartworm medicine now?(Required)

Yes

Describe your dog's general health.(Required)

Veterinarian's Name(Required)

Veterinarian's Phone(Required)

Veterinarian's Address

Street Address Address Line 2 City State ZIP Code

Grooming Information

Groomer's Name(Required)

Groomer's Phone(Required)

Groomer's Address

Street Address Address Line 2 City State ZIP Code

When was the dog last groomed?(Required)

How does the dog react to being groomed?(Required)

Behavior

Has this dog ever bitten anyone? If yes, please describe the circumstances.(Required)

Has this dog ever snarled, lifted his/her lip, nipped, or growled? If yes, please describe the circumstances.(Required)

How would you describe the dog's personality – happy, playful, nervous, fearful, hyperactive, aggressive, etc.?(Required)

Describe the dog's bad habits(Required)

Don’t worry! We know that no dog is perfect. Most cockers get into the trash, beg at the table, or jump on people. It’s important to tell the new owners what the dog has been used to doing in his pervious home.

Please list any other information that you feel might be helpful for the dog's new owner.(Required)

What kind of home would be ideal for this dog?(Required)

What kind of home should be avoided?(Required)

Additional comments or information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

Signature(Required)

Today's Date(Required)

Owner Information Form