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Adoption Request Form
ESSCLI - Rescue

Directions: If you would like to adopt a dog please fill out this form. This message will be sent to several persons in our organization. Someone will reply to your message and give you instructions regarding your next step. Please fill in ALL required fields. Any information you give us will be kept completely confidential.

Note: if you have trouble with this online form, you may download a PDF * version of the form here

*To view PDF files you will need Adobe Acrobat Reader. Download a free copy of Acrobat Reader at or go directly to

*Directions for PDF - fill in the information, click on the camera icon, then select the data, this will put the data on the clip board.  Paste into your word processor and send as an email attachment to . If you do not have the camera icon you must download a more up-to-date free version of Acrobat Reader.

Contact Information:
(* indicates a required field)
Name: *
E-mail: *
Phone: *

Please tell us about yourself:
Do you live in the: Town/City Country
Do you have a fenced-in yard? Yes    No
Have you ever owned a Springer? Yes    No
Which would you like to do? Adopt   Foster   Give up a Springer
If adopting, preferred age of dog?
How many children/grandchildren in your home:

Is there anything special about your situation? Tell us more!