Application – English Springer Rescue America

Adoption Application

"*" indicates required fields

This is a lengthy and detailed application.
This information will help us make the best match between the dogs and adopters.
Please allow sufficient time to complete it and have your veterinarian contact information ready.

Contact Information

Name of Adopter*

First Last

Additional Adopter (if applicable)

First Last

Mailing Address*

City*

State*

Zip Code*

Country*

Is your STREET address different than your mailing address?*

Yes

Street Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Do you have more than 1 residence?*

Yes

If you have more than 1 residence, please tell us more.

Where is it? How much time do you spend there?

Preferred Phone*

Other Phone

Type of Preferred Phone*

Cell

Landline

Texting on Preferred Phone*

(optional)

Text communication accepted

Texting not available

Email*

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

Enter Email Confirm Email

Prior Applications or Adoptions

Have you ever adopted or fostered a rescue dog before?*

Yes

Have you ever applied to ESRA in the past?*

Yes

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

Yes

If the answer to any of the above questions is YES, please provide details of where, when, and what organization; and if you were approved and if you adopted.*

Family & Home

Please list YOUR age AND the ages & names of ALL others in the household, including children.*

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

Yes

Please describe ages and frequency/type of visits.*

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

Tell us about stairs that dog might encounter in or outside of the home. How many? Inside? Outside?*

How long have you been at this residence?*

Do you own or rent?*

Own

Rent

If you rent or live in a condo, is a dog of 41-60 lbs. approved by your landlord?*

You will be asked to send this proof to your screening state.

N/A

Yes

Do you have a fenced yard?*

Yes

Invisible fencing

How high is the fence? What is it made from? What size is the fenced area? Is it attached to the house?*

Do you have access to a safe fenced area for exercise?*

Provide details of what outside places are available to your dog. How big is the unfenced yard?

If not, how do you plan on safely exercising and relieving your dog?*

Do you have a dog run or outside kennel?*

Yes

When is it used? Please provide details.*

Do you have a pool, spa, lake, ocean, or other water access?*

Yes

Water access*

Please describe. How is access to that controlled?

Do you have a dog/pet door?*

Yes

When does the dog have access? Where does the door open to?*

General Pet Questions

What are your reasons for wanting to adopt a Springer?*

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

Yes

Have you previously owned any other dogs?*

Yes

Do you currently have any dogs in the home?*

Yes

Current and Previously Owned Pets

We need a history of dog ownership. Please include:

Dog's name

Breed

Gender

Spay/Neuter status

AGE of any current dogs

Current dogs:*

We need a history of dog ownership. Please include:

Dog's name

Breed

Gender

WHEN you owned them (approximate years)

AGE when they passed on & WHY THEY PASSED

Spay/Neuter status

Prior dogs:*

Enter none if you have never been a dog owner in adulthood.

Have all of your pets been spayed or neutered? If not, tell us more.*

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

Yes

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

Do you own ANY other animals? In addition to cats, also include birds, reptiles, rodents, rabbits, horses, chickens, etc. Describe species and WHERE in the household or property these animals live.*

Tell us how your dog interacts with other dogs. Does he/she prefer opposite or same gender? Active or mellow dogs? Larger or smaller dogs?*

Pet Care

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.

Please tell us what issues you have encountered and how you managed the issue(s)?*

Tell us about your experience with training your dogs. How have you gone about that?

How did you handle house-training? Counter-surfing? Jumping? Have you taken classes? If so, when and what type?

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.

What heartworm preventative is/are your current or prior dog(s) on? How often?*

Please note that we will verify purchases with your vet. If you fill an online prescription, you will later be asked to send in receipts.

Are you familiar with flea/tick treatments?*

Yes

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

What preventative(s) have you used?*

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

Not yet 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.

What is your plan?*

Routines and Activities

Tell us about your typical routines away from home. When do you leave home? For how long? How many days of the week? How is your routine different on the weekends as opposed to the weekdays?*

Where will your dog stay when you are away from home during the day?*

If you have current dogs, where do they stay?

Where will the dog stay if you are gone for several days or longer, such as vacation or an emergency?*

Where will your Springer sleep at night?*

Please be specific.

What parts of the home will your Springer have access to or not have access to? Are dogs permitted on the furniture or not? Human beds?*

Some of our dogs come from homes where they are already accustomed to furniture/bed access but others already know to stay off those. This will help with our matching.

How active is your Lifestyle? Please be specific. What kind of activities might include your dog?*

What is your plan for your Springer to get an appropriate amount of mental and physical exercise and playtime each day?*

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/bench bred or field bred Springer?*

Show/bench

Field

No Preference

I'm not familiar with the differences.

Are you looking for a male or female?*

Male

Female

Either

Prefer male, but female would be fine

Prefer female, but male would be fine

Are you looking for a specific color?*

No Preference

Liver/white

Black/white

Liver Tricolor

Black Tricolor

Notes on Age:

Puppy & Adolescent phase goes up to age 2.

Adults are age 2 - 9.

Seniors are age 10+.

The typical Springer life span is about 13 - 14 years old.

Keep in mind that many Springers don't "settle down" until age 4 or more.

You CAN teach an older dog new tricks. They are very open to training at any age.

And a 5-8 year old is much easier to wear out so they can snuggle and be mellow in the house than a 1 - 3 year old.

What age range are you open to adopting?*

What type of activity level can you manage?*

Always-on-the-go, rain or shine

Needs to exercise and play vigorously every day, but relaxed after that

Calm and mellow, lower maintenance

Would you be open to sharing your heart and home with an older, more mature Springer (age 9 or older)?*

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

Would you consider a bonded pair of Springers?

Would you consider a Springer mix?*

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

Vet History

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.

NAME of your current veterinarian office.*

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.)

WHEN did you begin to use this vet?*

Additional Veterinarians

Have you visited any additional veterinarians in recent years?*

Please provide additional info for any vets in the past 5 years.

Yes, 1 more

Yes, 2 more

2nd Vet

Name of additional or prior veterinarian office (2)*

Phone number of additional/prior veterinary office. (2)*

WHEN did you use this vet? (2)*

3rd Vet

Name of additional or prior veterinarian office (3)*

Phone number of additional/prior veterinary office (3)*

WHEN did you use this vet? (3)*

Optional: Any comments about vet history that will aide us in completing your vet check.

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

Yes

No, Thank you

I'm already involved with ESRA

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.

Dogs in ESRA foster care are carefully evaluated by our dedicated volunteers, and we may ask many questionos of prospective adopters so that we can make just the right match between dog and adopter. The information you provide will help us do that. Please review our Privacy Policy here.

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Name

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