Boykin Spaniel Rescue, Inc.
"You become responsible
forever for what you have tamed."
--Antoine de Saint-Exupery
ADOPTION
APPLICATION
***This application is best viewed in MS Internet Explorer
Thank
you for your interest in adopting a Boykin Spaniel. The questions on this
application are designed to assess your suitability as a home for a rescued
Boykin Spaniel and to help us find the best possible match between you and the
dogs available through BSR. Please answer all questions as truthfully as
possible. There is a $250 adoption fee for each dog. We cannot accept this application via the Web at this time. Only applicants who return this form to the address provided will be considered. Please note, 58 cents postage is required to mail this application.
Boykin
Spaniel Rescue, c/o Dale Messerly, Jr., 410 Tate Ave., Culbertson, Ne. 69024
Name:
Home
Phone: __________________
Address:
Work
Phone: __________________
City:
State:
Zip:
_____________
Best
time to call: _____________________________Email:________________________
Occupation:
_____________________________________________________________
Name:
Phone:
_______________________
Relationship:
____________________________________________________________
Is
your residence a: __________ House
( rent own ) circle one
__________ Condo ( rent own
) Are pets allowed? Yes No
__________ Apartment Are pets allowed? Yes
No
__________ In the City
__________ In the Country
__________ In a Suburb
If
renting, do you have the landlord’s permission to keep a dog?
____________________
Landlord’s
name: ___________________________ Phone: _______________________
How
long have you lived at this address? ______________________________________
Do
you have a fenced yard? Fence
height: Type:
____________
Does
fencing completely enclose a yard for the dog? _____________________________
If
no fence, how will you handle the dog’s exercise and toilet duties?
How
many adults are in your household? How
many children:
Age
and gender of children:
Are
there regular visitors to your home (human or animal) with which your new
Boykin Spaniel must get along?
Do
you currently own other dogs? Are
they neutered/spayed?
Please
provide the breed, sex, and age of each:
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Breed |
Sex |
Age |
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Do
you own cats? How
many? Other
animals?
Name
of regular veterinarian: Phone#:
Address:
Have
you had dogs in the past? How
many?
Over
what period of time? What
breeds?
What
happened to them?
If
deceased, how?
Have
you or anyone in your family ever been convicted of an animal cruelty crime?
Have
you ever owned a Boykin Spaniel before?
If
no, have you researched this breed?
Why
do you choose this breed?
What
plans do you have for this dog? (Check all that apply)
House
Pet Guard Dog Hunting Dog
Obedience
Agility
Other
(describe)
Have
you ever obedience trained a dog?
Have
you ever crate-trained a dog?
Do
you plan to participate in obedience classes with the dog?
Do
you wish to adopt: Male Female No Preference
Age
Preference:
Are
you aware that any animal you adopt will have been spayed or neutered? Y N
Are
you prepared to deal with a dog who may have: A barking problem?
No housetraining? A digging
problem? No
obedience training?
Where
will the dog spend the day? Loose indoors? Crate?
Basement?
Garage? Fenced
Yard? Kennel Run?
Loose
Outdoors? Other (Describe)
How
many hours on the average will the dog spend alone?
Where
will the dog spend the night? Loose indoors? Crate?
Basement?
Garage? Fenced
Yard? Kennel Run?
Loose
Outdoors? Other (Describe)
Do
you travel frequently? Who
will care for the dog in your absence?
Are
you willing to pay to fly a dog if one is not available in your area?
Are
you aware it is an owner’s responsibility to keep current vaccinations and
heartworm preventative on a dog?
Do
you agree to license the dog and give regular healthcare?
Are
you able to spend $400.00 or more per year in vet bills for the life of the
dog?
Do
you agree to contact Boykin Spaniel Rescue, Inc. if you can no longer keep this
dog?
Are
you willing to let a representative of Boykin Spaniel Rescue, Inc. visit your
home by appointment? If no, why?
How
did you hear about Boykin Spaniel Rescue?
All of the above information I have given is
true and complete.
Applicant signature: Date:
WE
RESERVE THE RIGHT TO REFUSE AN APPLICANT
Thank
you for contacting Boykin Spaniel Rescue. One of our volunteers will be
contacting you shortly after receiving your paperwork. If you have not received
a response by phone or e-mail in 10 working days, email us at bsr@boykinrescue.org. Include your name, city, state and phone number with area code. We hope that you will be
contacted before this call becomes necessary, and in most cases you will be.
Please know our rescue volunteers handle a great deal of paperwork. This way
you can be certain your application gets the prompt attention it deserves. We
look forward to working with you.
FOR OFFICE USE ONLY:
Date Received: Reference
Checked: Date:
Contacted?:
Date:
Notes:
Dog adoption Complete: Dog: Date: