Application – English Springer Rescue America

NOTE: If your browser fills in form fields for you, please be sure to check all questions for accuracy!

Contact Information

Name*

First Last

Mailing Address*

(Please add your street address if different from mailing address.)

City*

State*

Zip Code*

Home Phone*

Cell Phone

Texting

(optional)

Text communication accepted.

Other Phone

Preferred Phone*

Cell
Home
Other

Email*

You will primarily be contacted via email - please monitor your spam/junk mail!

Enter Email Confirm Email

Have you ever applied to ESRA in the past?*

Yes
No

Have you applied to adopt or been approved to adopt through any other rescue organization?*

Yes
No

Have you ever been denied approval to adopt through any rescue organization?*

Yes
No

If the answer to any of the above three questions is YES, please provide us the name of that organization and their contact person, AND what name you used to apply.

Family & Home

Names and ages of ALL people in the household INCLUDING YOURSELF!*

Use the "+" button to the right to add lines. DON'T FORGET TO INCLUDE YOURSELF!

Name	Age

Names and ages of all persons in the household

Are there any children that visit your home or yard?*

Yes
No

Please describe ages and frequency/type of visits.

Why type of home do you live in? (Do you live in a house, apartment, condo or mobile home?)*

How long have you been at this residence?*

Do you own or rent?*

Own
Rent

If you rent, is a dog of 40-60 lbs. approved by your landlord?

Yes
No

Do you have a fenced yard?*

Yes
No

Type of fencing materials used and height?

Size of the yard available to the dog?*

Do you have a dog run or outdoor kennel?*

Yes
No

Do you have a pool and/or spa?

Yes
No

General Questions

Do you currently have any dogs in the home?*

Yes
No

Do you have visiting dogs in your home at times?*

Yes
No

Tell us more about the visiting dogs you have at times. (Type, gender, age.)

What are your reasons for wanting a Springer?*

Do you currently own or have you previously owned any Springers?*

Yes
No

Brief history and names of previously and currently owned Springer(s), and when you owned them.

If you now own or have previously owned other dogs, please give a brief history of each, mentioning names, genders, and breeds. Please also indicate spay/neuter status of each dog.*

Do you own ANY other animals? In addition to cats, also include birds, reptiles, rodents, rabbits. Describe species and ages and where in the household these animals live.*

Do you feel you know your dog's overall temperament well enough to know that he or she will accept a new dog in the home, and will you be able to handle any competitive and/or resource guarding behavior that may surface during the acclimation period of the new dog in the home?

Do you know if your dog prefers the company of same sex/opposite sex or older/younger dogs?

Do you know your dog's play style (i.e. vocal and on the sidelines, physical body slammers, wrestlers, chasers and tuggers, tentative soft touch players)?

Are you aware of the various issues (i.e. competitiveness, resource guarding for food, toys, resting spots, water, caretakers) that can lead to conflict and/or aggressive behaviors in multi-dog homes?

I am aware and have experience with these issues.
I am aware, but have not encountered these issues before.
I am not familiar with these issues, and need further information.

Do you feel you are prepared to manage and/or work with your dog(s) to help resolve any of the above issues if they should arise?

Have you ever attended dog training classes or utilized a trainer to work with your dog(s) in the past? If so, please detail when and what type.*

Are you planning on taking your new dog to training classes or using an in-home trainer?*

Yes
No
Maybe

Does anyone in the home have dog allergies?*

Yes
No

Will you promptly license your dog with the licensing authority for your area?

Yes
No

Do you know how often dogs need vaccinations, and what vaccines are necessary?*

Yes, I am aware.
No, I am not familiar with current vaccines, and need further information.

Are you familiar with heartworm prevention?*

Yes
No, I am not familiar with the choices, and need further information.

Are you familiar with flea/tick treatments?*

Yes
No, I am not familiar with the choices, and need further information.

Have you considered plans if you are unable to care for your dog(s) in the event of illness or death?*

Not applicable as I don't yet have any dogs.
No, I don't have a definite plan at this time, but will consider it or have some ideas.
Yes, I have a plan.

Are you familiar with portable dog crates and their uses?*

Yes
I've never used one and need further information.

Will you be crating the dog you adopt?*

If so, when and how long will the dog be crated? Where will the crate be located?

Number of hours per day that your Springer will be left alone.*

Where specifically will the dog stay when you are away from home?*

Where will your Springer sleep at night?*

How active is your lifestyle?*

How much time do you have for exercising your Springer?*

What type of exercise will your Springer have?*

Adoption Preferences

We urge you not to lock yourself into a certain gender, color or look. Once neutered or spayed, both males and females make equally wonderful pets. What separates them most are individual personalities. Like people, they come with their own special souls. Receive your English Springer with an open heart and mind. There is one waiting to win your heart, we promise!

Do you prefer a show or field bred Springer?*

Show
Field
No Preference

Are you looking for a male or female?*

Are you looking for a specific color?*

What is the age range of a Springer are you open to?*

Many Springers, especially youngsters, have lots of energy that needs to be spent before they will relax with you. Others are lower-maintenance inside companions, content to relax with you. What kind of Springer would fit in best with your household?*

Have you considered sharing your heart and home with an older, more mature Springer?*

Would you consider a Special Needs Springer (one with mobility limits, vision limits, or medication needs)?*

Would you consider a Springer mix?*

How far would you travel to meet and adopt a Springer?*

Would you give adoption consideration to a shelter dog, and agree to visit your local shelters during your adoption search?*

Yes
No

Are you able to consider an interstate adoption, and are you willing to pay the associated transport costs which may be involved, or drive the full distance?*

Yes
No
Depends on distance

The final decision about whether to send a dog long-distance is made by that state's coordinator. Please keep in mind that even though photos can be exchanged, you may not have contact with the dog prior to adoption. You must rely heavily on information provided by the foster home as to the dog's health and temperament.

Vet History

NAME of your veterinarian office. Please call your vet's office and specify to them that it is OK to release information to us about your past and present pets' health care.*

If you have been a client of this veterinarian or clinic for less than two years, please provide the prior vet information as well. If the account(s) may be under someone else's name, please provide that. (If you've never had a pet, you can enter N/A.)

Phone number of your veterinary office.*

(If you've never had a pet, you can enter N/A.)

How did you find out about ESRA?*

Are you interested in being contacted with information about how you can be further involved with ESRA's rescue activities?

Yes
No

Any further questions or comments?

Communication agreement*

I agree to monitor my email including spam/junk mail for contact from ESRA. I will also respond to phone contact (calls/voice mail) for the interview process.

By use of this form, I consent to my submitted data being collected and stored.
(For further information, please review our privacy policy.)

After submitting, look for the confirmation message. If not seen, check for missing data.

Name

This field is for validation purposes and should be left unchanged.