ESRA Membership Form

Note: Before hitting the submit key on this form, print out the ESRA Code of Ethics (Click here).  Each member must have a signed and dated copy on file with ESRA to maintain a valid membership. (If this is a joint membership application for two or more adults in the household, each one must sign the copy of the Code of Ethics.)  Mail or scan the Code of Ethics to the address on the form.  Also, be sure to fill out and submit this online form.  Both this ESRA Membership Form and the Code of Ethics must be completed for membership in ESRA.
Please use a desktop or laptop computer to fill out this form, as mobile devices (smartphones, tablets) are not always reliable for successful completion.

It is for the love and passion I hold for the English Springer Spaniel that I hereby pledge to:

  • Avail my support and assistance to English Springer Rescue America, Inc. (ESRA) whenever and wherever possible.
  • Help unwanted, abandoned and abused dogs for whom I know I can make a difference.
  • Kindly provide a safe and loving environment to those dogs temporarily in my care.
  • Assist fellow ESRA members in their rescue efforts where I know I can be of help.
  • Conduct my personal rescue efforts ethically and responsibly.
  • Endeavor in my words and actions to be honorable and dependable in promoting the English Springer Spaniel breed.
Full name
Email address
Phone number
City State Zip Code

Geographical area I can rescue in:

I can Volunteer to:
Foster (please submit a Foster Home Form)
Computer Work
Conduct Home Checks
Temperament Evaluations
Help with the website. Please note your software & experience:
Other. Please explain:

I would like to subscribe to:  
ESRA's Members Only Mailing List  

Additional Comments

By submitting this application, I also give my consent to receive electronic notices and communications from ESRA at the email address I have provided on this form.

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