Applicant Information

Personal Contact Information
First Last
City State Zip
Cross Streets
Phone Cell
Pet Interest and Pet Information
Name(s) of dogs you are interested in:
What age of dog were you looking for? 
What sex of dog were you looking for? 
Are you willing to accept a Corgi mix? 
Will your dog be:
Have you adopted from Arizona Cactus Corgi Rescue?
If yes, please list names of dogs:
Have you had pets before?
If yes, please list what types:
What happened to them:
How many animals do you currently have?  
Do you have a veterinarian?
Enter Hospital Name:
Enter Phone Number:
Do you agree to a home visit by AzCCR?
About Your Home and Family
Do you have children or routinely have children (ie. grandchildren, daycare etc) in your home?
If so, please describe (ie. how many, their ages, activity level)
   If you rent does your landlord allow dogs?
**For applicants who rent, please be prepared to show your rental agreement showing your landlord's pet policy.
   We live in a    Which floor?
   Does your residence have a dog door?
     If not, will you be installing one?
   Is your yard fenced?
     If so, what type of fence?        
   Does your home have a pool?
     If yes, is there a fence enclosing your pool?
   Where will your new dog be kept during the day while you are away?
   Where will your new dog be kept at night?
   Our family's activity level is:
When you are out of town, what do you plan to do with your dog?
If you move, what would you do with your dog?
How much do you expect, or are you willing to spend on medical expenses per year for your dog?
How did you learn about us?
By applying to meet an Arizona Cactus Corgi Rescue dog, I will not hold Arizona Cactus Corgi Rescue or any member thereof, responsible for any damage, injury or harm caused directly or indirectly by any dog I or a family member may decide to meet at any location.

I acknowledge that all the information contained in this form is true and correct to the best of my knowledge.

Your Signature:
Please enter code above