Greater Chicago Cavalier Rescue

         FOSTER/ADOPTION APPLICATION

 I/We are applying to become

        a Foster Family      an Adopting Family
Name     
Street Address     
Address (cont.)     
City/State/Zip     
Telephones       Home   Work  Cell
E-mail     
Occupation     
C

  Preferences     

 (or leave blank)    

Color: Blenheim     Tricolor     Black/Tan       Ruby
                  Sex: Male     Female

Reasons for wanting a Cavalier and for preferences:

       

                                   FAMILY STRUCTURE and LIFESTYLE

 1.  Do you live in a: house    apartment     townhome      other

 2.  Do you rent or own your residence? 

       If you rent, please provide your landlord's name and phone number:

                      

 3.  If you rent, do you have your landlord's permission to keep a dog?  Yes    No

 4. Does your city limit the number of animals you keep?   Yes    No

 5.  Do you have a fenced yard?   Yes    No
      If yes, please describe:         
   
 6.  Where will your Cavalier stay during the day?
    
7.  Where will your Cavalier sleep at night?    
   
8.  How and where will your Cavalier exercise and relieve itself?  
   
9.  How many adults are in your household?   
10.  Do children live in the household?   Yes    No   If yes, age and sex of each:
   
11. Who will be responsible for the care of your Cavalier?
   
12.  Have you previously owned a Cavalier?  Yes    No
      If no, how did you learn of the breed?
   
13.  Do you currently own any other dogs? Yes    No
       If yes, breed, sex, age and spayed/neutered for each:
   
14.  Do you own cats? Yes    No
     If yes, how many and how long?
   
15.  Are you willing to accept a Cavalier that has been diagnosed as having special medical 
       needs with potentially high medical costs?           Yes    No
16.  Are you willing to adopt a Cavalier with a history of neglect or abuse, who will
      demand a lot of time and special love and attention?           Yes    No
17.  Are you willing to accept a Cavalier with behavior problems who might require special
      training?          Yes    No
18.  On the average, how many hours per day will your Cavalier be without human companionship? hrs
       What will be the longest period the Cavalier might be left alone?     hrs   

19.  Where will the Cavalier spend time when humans are away?

               basement                                                   garage

               kitchen                                                       kennel run

               bathroom                                                   crate

               fenced yard

               specified area of home (explain)
         

20.  If you are faced with an emergency situation, who will care for your Cavalier?
     

21.  Are you willing to contend with seemingly endless shedding and some possible
       difficulty in potty training?          Yes    No

22.  Do you understand that rescue animals, in particular, might have issues that others
        might not, insecurities, quirks, and so on, and are you willing to work with your
        Cavalier to ensure him or her and yourself the best home life possible?
                  Yes    No

23. If you travel and cannot take your Cavalier, what plans will you make for its 
      safekeeping?
    

24.  Will you be willing to sign the Foster Home Agreement/Adoption Contract?

        (Ask for a copy or read at www.gccavalierrescue.org.)   Yes    No

25. How did you first hear about Greater Chicago Cavalier Rescue?
    
26. Is there anything else you would like to tell us about yourself? Any final comments?
    

 

The GCCR is a not for profit organization dedicated to the health and welfare of our breed and is run

strictly from donations received from the public. No person is ever paid for his/her efforts expended

as part of the GCCR.

The GCCR expects that each adopting family will give the GCCR an adoption fee to be applied to
boarding and veterinary expenses incurred by the organization. If you are adopting, your Cavalier will
arrive spayed or neutered (if not medically prohibitive) and up to date on shots. Any known health
needs of the Cavalier will be discussed with its foster family and adopting family at the time of placement.

I certify by typing my name below or signing this form that all information contained herein is true.
I recognize that completion of this application does not guarantee placement of a Cavalier in my home.
      Signature of Applicant       Date
      Signature of Co-Applicant Date
 

         THE FOLLOWING REFERENCES ARE REQUIRED AS A PART OF EACH
                                    FOSTER/ADOPTION APPLICATION

The GCCR requires references from foster and adopting families. These may include family members
not living with you, friends, business associates, etc.  We ask for two personal references plus one
from your veterinarian, if you have one (if you do not have a veterinarian, so indicate). Please include
below at least the name, address, and one phone number for each reference.

Personal reference #1

Name  

Address  

City/State/Zip  

Telephone  

 Home   Work  Cell

Email  

Personal reference #2

Name  

Address  

City/State/Zip  

Telephone  

 Home   Work  Cell

Email  

Veterinarian reference

Name  

Address  

City/State/Zip  

Office Telephone  

  

Email  

 

Thank you for your interest in the GCCR.  We look forward to meeting you!