Cochise Canine Rescue is located in Southern Arizona. We adopt throughout the state of AZ
Cochise Canine Rescue
PO Box 87 – Pomerene AZ 85627
Jeff Robbins and Sybil Erden -- Rescue coordinators
520-212-1718 ~~~ sybil85602@gmail.com
Adoption Application
This agreement is between Cochise Canine Rescue (hereafter referred to as CCR) and
(Your name) ___________________________________________________ (hereinafter referred to as Applicant.)
Applicant is interested in the
dog(name)____________________________ (breed)______________ approximate age_____years.
The Applicant allows CCR or CCR’s representative to call or write the below references including Veterinarians,
landlords et al in order to confirm the validity of the statements made below.
Name of Applicant(s):_____________________________________________________________________________
Address:_________________________________________City, State Zip:__________________________________
Phone Numbers:_________________________________________________________________________________
Own?___ Rent?____ If renting, name & phone # of Landlord_________________________________
(If renting you will need a letter from your landlord approving the keeping of this dog.)
Where will the dog(s) sleep? _______________________________________________________________________
Hours the dog(s) will be alone (without human supervision) during the day:_________
Where will the dog(s) be when alone?_____________________________________________________________
I have___ do not have____ a fenced yard.
Height and construction of fencing_________________________________________________________________
I do ____ do not ____ have a swimming pool.
If yes, it has ____ does not have____ fencing appropriate to keep this dog out of the pool.
Number of people in home:__________Ages of Children:___________________
Other pets/animals in home:_________________________ Ages:___________________________
If you had to move, where would your animals go?____________________________________________________
If you have to travel on business/vacation where will your animals go or who will care for them?________________________________________________________________________________________
Your Veterinarian:Name: __________________________________Phone #________________________________
Employer:Company and supervisor's name__________________________________________________________
Phone #______________________extension:__________
How long:____years_____months Position:________________________________________________________
2 non-related Personal references:
Reference #1 Name___________________________________phone #:_________________________________
Reference #2 Name___________________________________phone #:__________________________________
I understand that dogs/puppies can be destructive and am willing to train them and work with them to insure their future proper behavior.
I understand that if at ANY time I can no longer keep this dog, that s/he MUST be returned to CCR or a person/rescue selected by the CCR. The dog(s) MAY NOT go to a pound or shelter - if a CCR dog ends up in a shelter, fees equaling the cost of retrieving the dog(s) will be applied!
By my signature I affirm that the above is true and complete to the best of my knowledge and ability and that neither I nor anyone in my family have never been arrested for any form of animal cruelty, hoarding, dog fighting or cock fighting:
Signature:__________________________________________________Date:___________________
Signature:__________________________________________________Date:___________________
To adopt a CCR dog, after speaking with us on the phone to insure that you and your chosen dog will be a good fit, you will begin by filling out the Adoption Application. This will put an "adoption pending" on the dog of your choice. We will call your references including your veterinarian and, assuming you check out like the good animal parent we believe you are, next step is meeting the dog...
Any questions? Call us and we will be happy to help you.