Cavalier Adoption Information Form

The person adopting a Cavalier King Charles Spaniel must be over 18 years of age.

Name: ________________________ Date: ___________________

Home Address: ____________________

Telephone: _______________________

Mobile: _________________________

Email Address: ____________________

Are you Fulltime, Part time, Self Employed, Retired or unemployed?

____________________________________________________________

1. Have you had a dog before – Yes/No?

Yes No

If so what breed of dog was it?

____________________________________________________________

2. Reason for wanting to adopt a dog - Companionship for yourself/others - mate for
another dog, mate for another pet other than a dog, your children, other please specify?

____________________________________________________________

3. Do you own any other Pets – Yes/No?

Yes No

Please specify type, breed, age and temperament for each current pet?

____________________________________________________________

Desexed – Yes/N0

Yes No
4. What Age are you looking for - 4 years, 4-7 years, senior 8yrs +?

____________________________________________________________

5. What colour/sex would you prefer?

____________________________________________________________

6. Preferred personality – Confident, Playful, Lap dog,

Other -please specify.

____________________________________________________________

7. Would you consider a dog with special needs that is heart murmur, anxiety issues, deaf
or on medication - other?

____________________________________________________________

8. Will your dog be – indoors or outdoors?

____________________________________________________________

9. What would you feed your dog for its main meal or treats?
How often would u feed your new dog?

____________________________________________________________

10. Where will your new dog sleep?

____________________________________________________________

11. Would you consider adopting (rescuing) 2 dogs?

____________________________________________________________

12. Do you have any children at home?

____________________________________________________________
If so ages of your children please?

____________________________________________________________

13. Is anyone in your household known to be allergic to dogs or afraid?

Yes/No

Yes No

14. Are there likely to be any problems with the neighbours? Yes/No

Yes No

15. Do you have the time to look after a dog, including regular
bathing, grooming and exercise? Yes/No

Yes No

16. How much time are you prepared to spend walking/exercising

your dog?

Yes No

17. Would you be prepared to train your adoptive dog if needed? Yes/No

Yes No

18. How often would the dog be left alone?

____________________________________________________________

19. What would you do with your dog when you are on holidays?

____________________________________________________________

20. How many dogs does your Council allow you to OWN???
If you are not familiar with this please find out.
I need this Information please.

____________________________________________________________
21. Please answer this question as I need to know what is Your Budget that
you are able to afford for a Rescue Cavalier King Charles Spaniel Dog

____________________________________________________________

Residential circumstances

Please provide written evidence supporting approval allowing pets in your

rental property.

22. Do you rent/own or board?

Do you live in a House/Unit/Townhouse, Other – please specify

____________________________________________________________

Before submitting this form you must confirm that your Landlord/Real Estate
Agent/Body Corporate give you approval for allowing a dog to live with you in an
apartment please.

____________________________________________________________

Please provide name and contact details of your Landlord or Real Estate Agent, for
verification of approval to have a pet on the premises. Alternatively, please provide
written confirmation of approval from your Landlord/Real Estate Agent.

If you own and have a Body Corporate do the rules allow for pets?

____________________________________________________________

If yes what type?

____________________________________________________________

23. Do you have a securely fenced yard – Yes/No?

Yes No
Lockable side gate - Yes/No
Yes No
What is the height and type of fence?

_______________________________________________
24. Do you have a swimming pool – Yes/No?
Yes No
If so is it fenced – Yes/No?

Yes No

Have you, or any person in this household, ever been convicted of animal cruelty/neglect,
or had animals removed from your care? Yes/No

Yes No

If yes, please provide date and details

Yes No

Important Questions to Consider

Can you afford to maintain a dog?

____________________________________________________________

Are you aware that dogs shed hair and need grooming regularly?
____________________________________________________________

Approximate costs to maintain a dog include: Quality food $15-$20 a week, monthly flea
treatments, worming and heart worming $ 25- $35 a month.
____________________________________________________________

Can you afford Vet care – consultation – minimum $130 for a consultation then needles
before any other medication or treatment costs? Remembering if there are Health issues
this could easily be $400-$1200 or more depending on what the problems are.

____________________________________________________________

Do you have time to walk/exercise your new Cavalier?

____________________________________________________________
Adoption Application Declaration

Please give consideration to, the following:

I acknowledge a dog may live to 13 - 17 years and I am willing and able to meet the costs
that are likely to be necessary to care for my dog including ongoing costs of food, yearly
vaccinations, and regular flea and worming treatments plus washing/grooming the
Cavalier King Charles Spaniel regularly over its lifetime.
If my dog needs veterinary care I am willing and able to meet those costs.
I, and my family, will welcome our dog as a member of our family and provide a secure,
permanent and safe loving home.
I have the physical and financial capacity to include a dog to my family and will be able to
maintain a good standard of care.
I would never surrender my pet to a pound or animal shelter (putting it at risk of being
put down/euthanized). I would contact Cavalier King Charles Rescue to surrender the dog
back to ensure my pet goes to a new loving home, if my circumstances changed and I could
not keep it.
I confirm I am over 18 years of age and if I am in rental accommodation confirm I have
landlord permission to have a pet at the premises.
I have read, understand and agree to the ‘Adoption Terms and Conditions’
All answers supplied are true and correct and are not misleading in any way.

Print Name ______________________ Signature __________________

Date _______________________________
Terms and policies -

About our policies:

1. I have a No Kill policy.
2. All the animals I re-home are vet checked, vaccinated, de-sexed, micro-
chipped, heart wormed and wormed. Dogs are also flea treated and flea rinse
washed.
3. I screen potential adoptive families to ensure an appropriate match of the
Cavalier King Charles Spaniel and the new owners.
4. I monitor progress of adopted animals post placement to confirm rescue pets
and their new families are progressing well.
5. I am willing to take the Cavalier King Charles Spaniel back should the
placement not work out.
6. Should the adoptive family’s circumstances change in the future, I would
appreciate that you surrender the Cavalier King Charles Spaniel back to me.

Adoption Terms and Conditions

• A standard 7 day period is offered with every adoption to ensure a safe & suitable
match of the dog with its new home. Transfer of Ownership documentation is
completed at the completion of the trial.
• Payment of the Adoption Fee, together with completion of an ‘Adoption Agreement’
signed by both parties needs to be filled out when the rescue Cavalier King Charles
Spaniel is released to you.
• Decisions on adoption applications are based solely on an assessment of the
applicant’s capacity and commitment to provide a safe, loving and permanent home
for the pet under consideration.

Your adoption fee reimburses us for the routine veterinary work that is – desexing, dental
problems, vaccinations, heartworm and worming, flea treatments etc. No profit is made
by Cavalier King Charles Spaniel Rescue from rehoming rescued animals.