Applicant Information



Personal Contact Information
First	Last
Address
City	State	Zip
Cross Streets
Phone	Cell
e-Mail
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? Yes No
Will your dog be:
Outdoor Indoor Mostly Indoor Mostly Outdoor
Have you adopted from Arizona Cactus Corgi Rescue? Yes No If yes, please list names of dogs:
Have you had pets before? Yes No If yes, please list what types: What happened to them:
How many animals do you currently have?
Do you have a veterinarian? Yes No Enter Hospital Name: Enter Phone Number:
Do you agree to a home visit by AzCCR? Yes No
About Your Home and Family
Do you have children or routinely have children (ie. grandchildren, daycare etc) in your home? Yes No If so, please describe (ie. how many, their ages, activity level)
We Own Rent If you rent does your landlord allow dogs? Yes No **For applicants who rent, please be prepared to show your rental agreement showing your landlord's pet policy.
We live in a House Apartment Condo Other Which floor?
Does your residence have a dog door? Yes No If not, will you be installing one? Yes No
Is your yard fenced? Yes No If so, what type of fence? Block Wood Chain Link Other
Does your home have a pool? Yes No If yes, is there a fence enclosing your pool? Yes No
Where will your new dog be kept during the day while you are away? Inside Outside Access to indoors and outdoors Other
Where will your new dog be kept at night? Inside Outside Access to indoors and outdoors Other
Our family's activity level is: Very active and always on the go Moderately active, at home a few nights a week Not very active at home 5-7 nights Someone is always at home
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:

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