Name
*
First Name
Last Name
Email
*
Preferred Phone
*
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Occupation
*
Are you retired?
*
Do you have children?
*
Number of children in the household:
*
Please list names and ages of all household members.
*
Do you have visiting children under 10 years old?
*
Number of visiting children under 10 years old:
*
Please list the age range of visiting children and describe your relationship with them:
Dog gender preference:
*
Male
Female
Either
Dog color preference
*
Any
Red & White
Tricolor
Sable
Dog age preference (select all that apply)
*
Housing type:
*
House
Apartment
Condo
Townhouse
Mobile home
Other
Does your home have one or more flights of stairs?
*
Does your home have a fenced yard?
*
Please specify type of fencing and the height of the fence in feet.
*
Is your yard totally fenced in (no open or ungated 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
Please specify the type of gates, number of gates, and the height of gates.
*
Do you have a gardener?
*
Yes
No
Not applicable
If you have utility meters in your backyard, does a utility person need to enter the yard to read the meters?
*
Yes
No
Not applicable
If you have a pool, is it fenced in?
*
Yes
No
Not applicable
If you have a pool, do you have a pool service?
*
Yes
No
Not applicable
If you rent, do you have your landlord's permission to have a dog?
Yes
No
Not applicable
Are you required to make a pet deposit in order to have a pet?
Yes
No
Not applicable
If there's a pet size limit, please specify:
Name and phone number of landlord or rental manager
Do you currently have dogs?
*
Do you currently have cats?
*
Do you have currently have any other type of pets?
*
Please list type, age, and gender of current pets in your household.
*
Are your animals spayed/neutered?
*
If your animals are not spayed/neutered, please explain why:
*
Do you keep collars or ID tags on your pets at all times?
*
Yes
No
Not applicable
If not, please explain why:
Have you owned a dog before?
*
If you do not still have these animals, please explain why:
What reason, if any, would cause you to give up a family pet?
*
Have you had to euthanize a pet?
*
Yes
No
Not applicable
If so, what source did you use?
*
Veterinarian
Animal shelter
Not applicable
How many of your present or previous pets been adopted from animal shelters or rescue organizations?
*
1
2
3
4 or more
Not applicable
Do you or any family members have allergies?
*
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
Would you be willing to consider a corgi with special physical needs (for example, prescription food or medication)?
*
Yes
No
Unsure
Name, phone number and address of current vet:
*
Are you a member of any dog club?
*
Please list all dog clubs you currently belong to:
Have you trained a dog before?
*
Would you be willing to obedience train your dog?
*
What type(s) of training do you plan to do with your dog?
*
Will your dog be a house pet or an outside dog?
*
House pet
Outside dog
Both
Where would your dog sleep at night?
*
Why are you interested in adopting a corgi?
*
How far are you willing to travel to adopt a corgi?
*
When you go on vacation, what arrangements would you use for care of your pet(s)?
*
If we do not have a Corgi in our rescue at this time who is a match for your circumstances, would you like to be placed on our interest list?
*
