Form

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Birthday

Date

Who are you getting this dog for?

MyselfOther

If other, please list relation.

Number of adults (18+ years) in the home.

Number of children (0-7 years) in the home.

Number of children (8-17 years) in the home.

Is anyone in the home known to be allergic to dogs?

Where will your dog stay during the day/night?

What type of residence do you live in?

Do you rent or own your home?

If renting, does your landlord give permission for you to have pets?

On average, how many hours will your dog be alone?

Who will have primary responsibility for this dog?

Have you owned dogs before?

If yes, please explain their quality of life and what happened to them.

Have you ever surrendered or given away a pet?

If yes, please provide the reason.

Are there any other dogs in your household?

If yes, please list breed, age, sex, and if they are fixed.

Do you have any other pets in your house?

If yes, please list species and age.

Please provide the name and telephone number of your veterinarian.

Do you have a fenced yard?

Under what circumstances would you return your dog?

Have all household members agreed to the dog?

Have you ever been convicted of neglect or animal cruelty?

Are you willing to send photos of the dogs environment?

Please describe the gender you prefer and any special markings you would like to see.

Falsified information will result in automatic rejection of this application.
Corgi Creek reserves the right to refuse any applicant.

I understand it is my responsibility to do research and understand the breed of dog I may be bringing home. This decision should not be impulsive, but a carefully thought out decision.

Signature

Date

Questionnaire