If you prefer, you can Download Application here, fill it out

and fax to: 603.434.2620 or email it to: submit@corgisncritters.org

Or fill out the application online below:

Application for Adoption

NAME OF DOG APPLIED FOR (you may leave blank if this is a general application):

Applicant: Please provide the following contact information:

Name
Street Address
Address (cont)
City/State/Zip
Work Phone
Home Phone
Cell Phone
Email

Co-Applicant (if applicable): Please provide the following contact information:

Name
Street Address
Address (cont)
City/State/Zip
Work Phone
Home Phone
Cell Phone
Email
Relationship

CNC coordinates with other rescue groups in finding appropriate homes for any corgi in need. It is not unusual for applicants to apply with more than one group. Please list any rescue group you have applied with, their contact information, and when you applied, and the outcome of that application:

Rescue
Address
City/State/Zip
Contact
Rescue Phone
Contact Email

What was the outcome of this other application (pending, denied, adoption, etc.)?

(Note: We do not discriminate against renters, HOWEVER you MUST provide written permission by the Landlord for you to adopt this dog.)

Check all that apply:

Own Rent

House  Condo  Apt.  Mobile Home

Rural  Urban Subdivision

Do you have a fenced yard?  Yes

If no fence, what arrangements will you have for the dog’s exercise and toilet area?

Do you have a swimming pool?   Yes

If "yes," is it secure so the dog cannot fall in?   Yes

Where will this dog be kept? (Inside only, outside only, crated loose in the house, etc):

Number of Adults in your household?   
How many Children in the household?
Ages of children?

Do all family members agree with this adoption? Yes  

Is anyone in the home allergic to dogs? Yes  

If "yes," how will the allergy be controlled?

How many hours of the day is there an adult at home?

Describe a typical weekday in your home:

Describe a typical weekend in your home:

How often do you travel that would necessitate the dog to be boarded or left with a pet sitter?

Past Pets:

For each pet you have owned in the past 10 years (but do not currently own), please provide: · Breed/Species · Year Acquired/Duration of Ownership · Why do you no longer have this pet?

Past Pets (use "/" to separate pets)

Why do you no longer have these animals?

Current Pets:

Please provide the following for your Current Pets:

Current Pet:

If not altered, why not?

Current/past illnesses or injuries:

Current Pet 2

If not altered, why not?

Current/past illnesses or injuries:

Are all current pets up-to-date on vaccinations?  Yes

If "no," please explain:

Are all currents pets on flea/tick/heartworm preventative?  Yes

If "no," please explain:

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Veterinarian References:

Please provide information for all veterinarians your pets have seen in the past 10 years:

Current or Past  Vet Reference

Vet's Name
Clinic Name
Street Address
Address (cont.)
City/State/Zip
Phone
Fax
E-mail
Pets seen

Additional Vet Reference:

Vet's Name
Clinic Name
Street Address
Address (cont.)
City/State/Zip
Phone
Fax
E-mail
Pets seen

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Have you done any type of research on this dog’s breed(s) characteristic?   Yes

Have you ever owned this breed(s) before?  Yes

Why do you want this particular dog/breed?

Are you willing to housetrain this dog if necessary?     Yes

Are you willing to have a home visit prior to the adoption?    Yes

If you do not agree to a home visit, please explain why:

Do you have any additional questions before we proceed?

Is there anything else you feel we should know that would help us process your application?

Corgis & Critters NET Rescue, Inc., a 501(c)(3) corporation

Copyright © 2007 All rights reserved. 

Graphics by Colleen at Colleen's Critter Creations.