KEPZ Corfu Adoption Application Form

Thank you for your interest in adopting one of our dogs. KEPZ is a shelter for dogs located in Agios Ioannis, Corfu. It is run by volunteers and relies totally on donations from kind people like you.

You are welcome to visit to choose your dog and meet the volunteers. To make an appointment either email kepzcorfu@gmail.com or message through our Facebook page https://www.facebook.com/Corfiotunionforrescuinganimals. We can arrange for the dog to come to you wherever you live but we will need you to fill in this form first and also to have a home assessment before we agree that you can adopt. There is an adoption fee of 150€.

Full Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityCounty

Postal / Zip Code

Country*

Phone Number*

Country CodeArea CodePhone Number

Tell us why you are looking to adopt a dog

Your home. Do you*

OwnRentOther

If renting please give details of the lease. Are animals permitted?

Location*

TownCityRural

Describe your home environment*

Busy/Noisy / Many guestsModerate Comings and GoingsQuiet with occasional Guestslots of other animals/children

Does anyone in your household have allergies to dogs?*

YesNo

Are all members of your Family agreeable to the Adoption?*

YesNo

Please List any Pets you currently have in your home*

Do you have a preference in sex of the dog?*

MaleFemaleNo preference

Do you have an age preference?*

YesNo

If Yes to the above, what age would you prefer?

What size dog would you prefer? (Check all that apply)*

smallmediumlarge

Are you willing to put in time, love and patience to train the dog ?*

YesNo

Have you had any experience with with an emotionally or physically neglected, or abused dogs?*

YesNo

If Yes to the above please elaborate

Are you willing to use a crate for a dog if recommended?*

YesNo

Do you have a fenced/walled garden area?*

YesNoPartial

If Yes or Partial to the above please give some detail (Height of fence, construction, access)*

Upload a photo of your garden area

Are you in full or part time employment?*

YesNo

If Yes to the above please give details

How many hours in a day would the dog be left alone?*

Please list your plans to exercise your dog (walks, parks, agility training, duration of exercise etc)*

Name of current Vet used or you intend to use*

Veterinary Practice*

Vets Phone Number*

Country CodeArea CodePhone Number

Will you insure your new dog?*

YesNoUnsure

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully. I understand that applying does not ensure approval and I accept that KEPZ will put the needs of the dog as the first priority. I certify that the above information is correct, and I understand that the information will be verified. Your personal details will not be shared with anyone except the people involved in the application process and those associated with the services of home checking for this animal.

KEPZ Dog Adoption Application Form