Application to Adopt

Your phone number (with area code):
Address (if PO or RR or RD box, please include approximate street address):

City/Town: State/Prov.: Post./Zip Code:

In order to ensure the safety of our Springers and to guarantee our ability to reclaim them if necessary, MAESSR only places dogs in Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia, New Jersey.

How did you learn about MAESSR?:

Internet: Petfinder.Org	Internet: Search Engine
Internet: Yahoo	Internet: Other
Friend or Family Member	Veterinarian
MAESSR Volunteer	MAESSR Adoptive Family
MAESSR Poster	Rescue Fair
Other Rescue or Shelter	Other

Occupation(s)

Number and Ages of children living in the household or visiting regularly:

If you plan on having children in the future, what will you do with your rescue Springer?

What type of area do you live in: suburbs, city or country?

Do you own or rent?
House or Apartment?

If you rent, do you have written permission from your landlord to keep a dog?
Will you provide a copy of that permission to MAESSR?

Is there a weight limit for dogs in residence at your rental property?

If you own a condominium, will you provide a copy of your condominium's pet policy?

Please provide the name, phone & fax (if available) number of your veterinarian:

May we call your veterinarian?

What other pets live in your home (please include age, sex, whether or not the pet has been spayed/neutered &, if cat, declawed)?:

Have you ever been convicted of animal cruelty, abuse, and/or abandonment pursuant to any past and/or present laws of the State(s) or municipality(ies) where you have lived in the past or currently reside? Yes No

Have you ever owned a dog before? Yes No

Have you ever given up or euthanized a dog in the past? (please give details):

Have you ever rescued a dog before? (please give details):

Have you ever owned an English Springer Spaniel before?

What do you know about English Springer Spaniels?

What sex/age/color Springer are you interested in?

Would you consider opening your heart and home to a senior Springer, 8 years or older?

Would you consider a "special needs" Springer?

Do you have a fenced yard?
If you don't have a fenced yard, how will your rescue Springer be exercised?

What kind of activities do you plan on participating in with your rescue Springer?

Have you ever taken a dog to an obedience class?
Will you be taking you rescue Springer to an obedience class?

Where will your rescue Springer be during the day?

Where will your rescue Springer be at night?

Are you familiar with the use of a crate?
Will you be crating your rescue Springer?

If you move, what will you do with your rescue Springer?

Do you agree to a personal interview with one of our volunteers?

MAESSR requires that all adults living in the home be present while conducting our telephone interview? Please take this into consideration, when setting up your interview date and time with our volunteer.

Do you agree to a home visit by one of our volunteers?

You will be contacted by one of our volunteers who will ask for the name of your most recent veterinarian or two personal references who are familiar with your interactions with animals if you haven't had a veterinarian at all or recently. Please have the information ready when contacted by your interviewer, it will make the review process quicker.

Effective 2/1/07, MAESSR's adoption fees will be $300 for puppies 6 months of age and under, $250 for dogs under the age of 3, $200 for dogs between 3 and 7, and $150 for dogs 8 and over. This fee defrays but does not cover the costs of alteration, veterinary care and immunizations.
Are you prepared to pay an adoption fee?

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