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 ~~~

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:




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.