Corgi Rescue Pre-Adoption Application

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DOG OWNERSHIP IS A LIFETIME COMMITMENT

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Please look over this form, enter the information, and then press the 'Submit Form' button at the bottom of the page. This form will be automatically sent to the PWCCSC Corgi Rescue contact.

If you want to clear all the form's information and start over, press the 'Reset Form' button at bottom of page, re-enter the information, and press the 'Submit Form' button. This form will then be sent to the PWCCSC Corgi Rescue contact.

Finally, if you want to quit this form altogether; click HERE or on the 'Return to Corgi Rescue' page link at the bottom of this page. Nothing will be sent.

Date:
Name:
Street Address:	|
City:		State:	CA AZ	Zip Code:
Home Phone:		Work Phone:
Cell Phone:
Email Address 1:		Email Address 2:
Occupation:		Retired:

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Do you have children? No Yes Number of Children: None 1 2 3 4+

Please list names and ages of all Household Members:

Do you have visiting children under 10 years old? No Yes       Number visiting children:  None 1 2 3 4+

Please list names and ages of visitors under the age of 10 years:

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Type of Dog Wanted:  Breed Type: Purebreed Mixbreed Either Age Range: Sex: Male Female Either   Color: Any Red & White Tri-Color Sable

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Housing Type:  House Apt. Condo Townhouse Mobile Home Other Does your home have one or more flights of stairs? Yes No

Have Fenced Yard? Yes No Type of Fencing: Wood ChainLink Concrete Brick Wrought Iron None

Height of Fencing: Lowest and Highest in feet: 1-3 Feet 4-5 Feet 6 + Feet Not Applicable

Is your yard totally fenced? (no open or un-gated areas) Yes No Not Applicable

Is your yard attached to the house with an opening directly from the house to the yard? Yes No Not Applicable

Type of gates: None Wood ChainLink Wrought Iron    How many gates: 1 2 3 4+ Not Applicable     Height of gates: 1-3 Feet 4-5 Feet 6 + Feet Not Applicable

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Do you have a gardener? Yes No     Do you have a pool service? Yes No

If you have a pool, is it fenced in? Yes No Not Applicable

Do you have utility meters in your backyard? Yes No

 If so, does a utility person need to enter the yard to read the meters? Yes No Not Applicable

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If you rent do you have your landlord’s permission to have a dog? Yes No Not Applicable

Have you been required to make a pet deposit in order to have a pet? Yes No Not Applicable

Is there a pet size limit? Yes No Not Applicable    If yes, what is the pet size limit?

Name and phone # of landlord or rental manager:

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Do you currently have   Dogs: Yes No    Cat's:   Yes No     Other Type Pets:  Yes No

Please list the type, age, and gender of current pets in your household:

 Have you owned other dogs?   Yes No

  If you do not still have these animals, please explain?

What reason, if any, would cause you to give up a family pet?

Have you had to put a pet to sleep?  Yes No   If so, what source did you use?  Veterinarian Animal Shelter Not Applicable

Have any of your present or previous pets been adopted from animal shelters rescue organizations? Yes No Not Applicable

How many been adopted from animal shelters or rescue organizations? 1 2 3 4 5+ None

 Have you ever acquired a pet through another Owner, Neighbor, Give-Up Advertisement, Friend, Co-worker? Yes No Not Applicable

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 Do you or any family members have allergies? Yes No Some

Rescued dogs take time to adjust and some have special needs.  It takes patience and can add stress. Are you are up to the challenge? Yes No Unsure

 Name and phone # or address of vet:

Are you a member of any dog club? Yes No Pending     Name of Club:

Have you trained a dog before? Yes No

Would you be willing to obedience train your dog? Yes No

Will your dog be a house pet or an outside dog? House Dog Outside Dog Both

If both, explain where the dog would sleep at night:

Are your animals spayed/neutered?  Yes No Not Applicable

If not, please explain why:

 Do you keep collars and ID tags on your pets at all times?  Yes No

If no, explain why:

When you go on vacation what arrangement would you use for care of your pet(s), boarding kennel,

keep with family member or neighbor, pet sitting service, take pet with you?

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Why are you interested in adopting a corgi?

How far will you travel to adopt a corgi?

Would you like to be placed on our interest list? if we do not have a corgi in our rescue at this time who is a match for your circumstances ? Yes No

Click Here to Stop Now and Return to Rescue Page

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