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Adoption Application

Fields marked with an * are required

We are one of a very few holistic rescues. We believe in healing and nurturing the body with products that come from the earth. We will expect any adopter to feed a naturally sourced balanced diet (raw), keep vaccinations to a minimum, and avoid all toxins.  Please initial that you have read this statement and understand.

I/We are applying to: *

How committed are you to adopting?:*

How many other rescues have you applied with?:*

Have you submitted an application to a breeder for puppy/dog?:

Preferred Dog Age: *

check all that apply

Dog Color Preference:

Tell your preference for a Cavalier color or leave blank

Gender Preference:

Leave blank if no preference

First Name: *

Last Name: *


Street Address: *

City: *

State: *

Postal Code: *

Phone (home): *

Phone (Mobile):

Phone (work): 

Email (applicant): a copy of your submission will be emailed to you if email provided

Current Employer:

Job Title:


Residence Information:

Please describe where you live

Rental/Apt is OK for Pet?:

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

Do you have a fenced yard?:

Do you have/use a Doggie Door?:

Landlord name and number (if renter):

City Limit for Pet:

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

Yard Description:

Tell us about your children, including ages:

(if they reside in household dog will be kept)

Do you have other pets?: *

Tell us about your other pets (species, breed, age).  Enter none if no other pets: *

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

What are you currently feeding your other dog(s) or plan to feed your dog?: *

Note:  We are a holistic rescue and all dogs in our care are fed a naturally sourced raw diet. Not providing an answer will result in an automatic denial

Have you ever surrendered a pet?*

What do you use for flea and tick prevention?: *

Who will be responsible for your Cavalier?: *

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

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

Where will your Cavalier be allowed during the day?: *

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

How many hours a day on average will your Cavalier spend without a human?: *

Cavaliers in need of training?: *

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

Have you owned a Cavalier previously?: *

Who will be your Cavalier caregiver in an emergency?: *

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

What will be your Cavalier exercise plan?: *

How and where will your Cavalier exercise and relieve itself?

I understand that rescued Cavaliers may...*

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

How many hours a day maximum will your Cavalier spend without a human?: *

Accepting of Cavaliers with special needs?: *

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?

Willing to accept neglected or abused Cavaliers?: 

 Veterinary Reference: *

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

*You will need to call your vet and let them know that you authorize Cavalier Rescue Midwest to contact them

Personal Reference #1: *

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

Readiness to rescue a Cavalier self rating:

Adopter Signature: *

I certify that information contained herein is true.  I recognize that completion of this application does not guarantee placement of a Cavalier in my home.

(Type full name in box)

How did you find Cavalier Rescue Midwest?:

Personal Reference #2: *

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

Note from Applicant: 

Adopter Signed Date: *

Your content has been submitted, a Cavalier Rescue representative will review your application and reach out to you.

We are sorry, an error occurred, please check that all required fields are filled in and try again.

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