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Greater Chicago Cavalier Rescue

ADOPTION / FOSTER APPLICATION

Greater Chicago Cavalier Rescue (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.

GCCR asks for detailed information with the intent to match each rescued Cavalier with the best home possible. 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).

Note: Field help is given below the field, where appropriated.

1. I/We are applying to: *

Adopt Foster

2. Dog Preferences

Blenheim Black and Tan Ruby Tri-Color

Tell your preference for a Cavalier Color or leave blank.

3. Gender Preference?

Male Female

4. I understand that rescued Cavaliers may....

Please check the boxes that you agree are common traits of a rescued Cavalier.

5. First Name *

This field is required.

6. Last Name *

7. Co-applicant

8. Street Address *

9. City *

10. State *

11. Postal Code *

12. Phone-Home *

13. Phone-Work

14. Phone-Mobile

15. Email (Applicant) *

16. Current Employer

17. Job Title

18. Number of Adults: *

How many adults reside in this home?

19. Number of Children?

20. Tell us about your children:

21. Residence *

22. Residence Information

Please describer where you live. If you rent, please provide your landlord's name and phone number? If you rent, do you have your landlord's permission to keep a dog?

23. Rental / Apt is Ok for Pet?

Yes No

Only answer this question if you are a renter. Yes indicates that you have your landlord's permission to keep a dog.

24. City Limit for Pet

It will necessary for you to know if there is limit of dogs (pets) imposed by a local ordinance. Please check with your village or city.

25. Do you have a fenced yard? *

Yes No

26. Yard Description

27. Cavalier Exercise Plan: *

How and where will your Cavalier exercise and relieve itself?

28. Emergency Caregiver? *

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

29. Travel Care Plan.

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

Please check the location in your house that your Cavalier will have access to during the day.

Please check the location in your house where your Cavalier will sleep.

32. Who will be responsible for the Cavalier? *

In your household, who will be the primary person responsible for the Cavalier's health and wellbeing?

33. Hours per day alone (no human present) *

What is the average amount of time that your Cavalier will be alone during the day? What is the maximum amount of time that your Cavalier will be alone during the day?

34. Cats at home?

Yes No

35. Tell us about your cat(s):

If you have cats, tell us about the number of cats that are in your home and how long they have been with you.

36. Accepting of Cavaliers with special needs? *

Yes No

Are you willing to accept a Cavalier that has been diagnosed as having a medical need that will require daily medications and frequent visits to veterinarians or specialists?

37. Cavaliers in need of training? *

Yes No

Are you willing to accept a Cavalier that has behavior problems and might require special training?

38. Willing to accept neglected or abused Cavalier? *

Yes No

39. Knowledge of Cavalier breed?

How did you gain your knowledge and awareness of the Cavalier breed?

40. How did you find GCCR?

41. Do you have other dogs? *

Yes No

42. Tell us about your other dogs:

If you have other dogs, please tell us the breed, gender, age, spayed/neutered for each.

43. Have you owned a Cavalier previously? *

44. Veterinary Reference *

Please provide name, address, city, state, zip, office phone and email for your veterinarian references.

45. Personal Reference #1 *

Please provide name, address, city, state, zip, email address, and phone for your personal references.

46. Personal Reference #2 *

Please provide name, address, city, state, zip, email address, and phone for your personal references.

47. Readiness to rescue a Cavalier self-rating: *

48. Note from Applicant

49. Waiver - Adopt/Foster *

- I accept the GCCR Adoption /Foster Waiver

The Applicant(s) hereby forever releases, discharges and covenants to hold harmless the Greater Chicago Cavalier Rescue and any other person, firm or corporation charged or chargeable with responsibility or liability, their heirs, administrators, executors, successors and assigns, from any and all claims, damages, costs, expenses, loss of services, actions and causes of action belonging to the Applicant(s), arising out of any act or occurrence pursuant to this application, and particularly on account of Greater Chicago Cavalier Rescue's placement of a Cavalier in the Applicant's care.

50. Adopter/Foster E-Signature *

I certify by typing my name and today's date that all information contained herein is true. I recognize that completion of this application does not guarantee placement of a Cavalier in my home.

51. Adopter E-Signature Date *

I certify by typing my name and today's date that all information contained herein is true. I recognize that completion of this application does not guarantee placement of a Cavalier in my home.

52. Co-Applicant E-Signature

I certify by typing my name and today's date that all information contained herein is true. I recognize that completion of this application does not guarantee placement of a Cavalier in my home.

53. Co-Applicant E-Signature Date

I certify by typing my name and today's date that all information contained herein is true. I recognize that completion of this application does not guarantee placement of a Cavalier in my home.

Greater Chicago Cavalier Rescue 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.

We look forward to meeting you!

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Backyard	Basement	Bathroom	Bedroom
Dining Room	Family Room	Garage	Kitchen
Laundry	Living Room	Other

Backyard	Basement	Bathroom	Bedroom
Dining Room	Family Room	Garage	Kitchen
Laundry	Living Room	Other