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Pembroke Welsh Corgi Club of the Garden State RESCUE ADOPTION APPLICATION Please complete the following information to assist our Rescue Committee in our efforts to select a suitable Pembroke Welsh Corgi for you and your family to adopt. This information will be helpful in determining that a proposed adoption is in the best interests of the both the rescue corgi and you & your family. In answering these questions, feel free to attach additional pages if necessary. Your application will be held in active status for one year from the date of application. After one year if you wish to remain on our active list of potential adoptive families, please contact us to communicate your continued interest. Also, if after you have submitted an application for a rescue adoption you either get another dog or decide that you no longer wish to adopt a Pembroke, the PWCCGS would appreciate it if you could let know so we can update our records. ABOUT YOU Name: _____________________________________________________________________________ Street Address: _______________________________________________________________________ City: _________________________________________ State: ______________ Zip: ____________ Home Phone # with area code: ____________________________ Best Time to Call: _________________ Email Address: _____________________________________ Occupation(s): _______________________________________________________________________ How did you find out about us? __________________________________________________________ List all persons that live at this home, including ages and interests: Name Age Interests ADULTS CHILDREN Which persons in the household are interested in adopting a Pembroke? _________________________ ____________________________________________________________________________________ Do you belong to any dog clubs? ____No ___ Yes (If yes, please specify) _____________________ PWCCGS thanks Mayflower Pembroke Welsh Corgi Club Inc for permission to adapt this application. DESIRED PEMBROKE FEATURES Age Range: _____________________ Sex: _____________ Color: __________________________ Would you consider a senior dog (8 years or older)? _________________________________________ Would you consider more than one dog? __________________________________________________ Would you consider a dog that has a physical problem that might be controlled or cured with the use of diet, drugs, or surgery? ________________________________________________________________ Would you consider a dog that has an emotional problem (ex., separation anxiety, fear aggression) that might be controlled or cured with training, behavior modification, or the use of drugs? ____________________________________________________________________________________ Pick the 5 most important descriptions of what you are looking for in this new dog: _____obedient _____playful _____easy going _____energetic _____athletic _____calm _____outgoing _____quiet _____playful _____couch potato _____housetrained _____good in car _____good with kids _____affectionate _____for performance/agility/sports _____good with other dogs _____walking/hiking companion _____eager to bond _____needs nurturing _____no issues with people _____ good on a leash ABOUT YOUR HOME What type of dwelling do you have? Apt / Condo _____ Detached Home _____ Duplex _____ Farm _____ Mobile Home _____ Setting: Urban _____ Suburban _____ Rural _____ Do you: Rent _____ Own _____ If you rent your home, do you have permission from your landlord to have a dog? _____ Yes _____ No (Please be able to provide an approval letter from your landlord.) If a condo or townhouse, do restrictive covenants permit dogs? _____ Yes _____ No Do you have a yard? _____ Yes _____ No If yes, is it fenced? _____ Yes ______ No If not fenced, how do you plan to ensure that the dog receives safe and adequate exercise? ____________________________________________________________________________________ Are there children in the neighborhood, do children/grandchildren visit you, or do you plan to have children in the future? (Describe) ____________________________________________________________________________________ Are there other dogs in neighboring yards? _____ Yes _____ No If yes, to the best of your ability, describe the personality of those animals _________________________ ____________________________________________________________________________________ Are any household members allergic to dogs? _____ Yes _____ No PWCCGS thanks Mayflower Pembroke Welsh Corgi Club Inc for permission to adapt this application. HOUSING AND CARING FOR THE ADOPTED DOG How did you learn about Pembroke Corgis? _______________________________________________ Please detail any experience you’ve had with Pembroke Corgis in the past. _______________________ ____________________________________________________________________________________ Why are you interested in adopting a Pembroke? ___________________________________________ ____________________________________________________________________________________ Who would primarily be responsible for caring for the Pembroke? ______________________________ Where will your dog spend the day? ______________________________________________________ Where will your dog spend the night? ____________________________________________________ Would there be people at home during the day? _____ Yes _____ No Approximately how many hours per day would the dog be left alone? ___________________________ Where would the dog eat? ______________________________________________________________ How would the dog get play/exercise, and how much? _______________________________________ ____________________________________________________________________________________ Do you plan to enroll your dog in a training/obedience class? _____ If so, where? ________________ ____________________________________________________________________________________ Have you trained a dog before? _________________________________________________________ When you go on vacation, what would be the arrangement to care for your pet(s)? _________________ ____________________________________________________________________________________ Even if the Pembroke had been previously housebroken, you should expect that it would not be housebroken, at first, in a new home. This may be temporary or it may require retraining. How would you deal with this issue? ____________________________________________________________________________________ ____________________________________________________________________________________ Dogs may become destructive when left alone, but there are ways to train them not to chew or mess in the house when left alone. How would you deal with this? ____________________________________________________________________________________ Would you be willing to confine a dog to a crate for certain periods during the 1st few weeks or months after it arrives in your home? ___________________________________________________________ ____________________________________________________________________________________ PWCCGS thanks Mayflower Pembroke Welsh Corgi Club Inc for permission to adapt this application. Pembrokes shed heavily about 2 times per year: combing, grooming, nail care is required. How are you prepared to deal with the grooming needs of the dog? ________________________________________ ____________________________________________________________________________________ The Pembroke may not initially get along with any other pet that you may now own or in the future. How would you handle this situation should it arise? ____________________________________________________________________________________ The Pembroke will need vaccinations, heartworm medication, and regular veterinary care. It may become ill and require costly medical treatment. Are you willing and able to provide this care if needed? _____________________________________________________________________________ ____________________________________________________________________________________ OTHER PETS Do you currently have other pets in the home? _____ Yes _____ No If so list all: Type (dog, cat, bird,etc.) Breed (if known) Describe Personality Age Sex Neutered ? Vaccinations (M or F) (Y or N) Up to Date? (Y or N) How do these pets behave with dogs, and if they are dogs, how do they behave with strange or new dogs? ____________________________________________________________________________________ Have you owned any other dogs before? _____ No _____ Yes If yes, please describe how long you had them, and what happened to them: ________________________________________________________ ____________________________________________________________________________________ What experience have you had around dogs in general? ______________________________________ ____________________________________________________________________________________ Have any of your present or previous pets been adopted from an animal shelter or rescue organization? _____ No _____ Yes If yes, how many? ______________ What reason, if any, would cause you to give up a family pet? _________________________________ ____________________________________________________________________________________ PWCCGS thanks Mayflower Pembroke Welsh Corgi Club Inc for permission to adapt this application. REFERENCES Please list the name and contact information for 2 references who can speak to your fitness as a pet owner in general, and more specifically, as the owner of a rescue dog. If you currently own or have in the last five years owned a pet, please include your veterinarian as one of the references. Reference 1: Relationship to you: _____ Veterinarian Other (Specify) _________________________________ Name: _____________________________________________________________________________ Street Address: ______________________________________________________________________ City: _____________________________________ State: _____________ Zip __________________ Home Phone # with area code: __________________________ Best time to call: ___________________ Reference 2: Relationship to you: _____ Veterinarian Other (Specify) _________________________________ Name: _____________________________________________________________________________ Street Address: ______________________________________________________________________ City: _____________________________________ State: _____________ Zip: _________________ Home Phone # with area code: __________________________ Best time to call: ___________________ THANK YOU! for the time you have taken to complete this application. Please return the application by email (preferred) or by USPS to: Carol Wyatt 114 Hilltop Road Basking Ridge, NJ 07920 carol@wyattmail.com PWCCGS thanks Mayflower Pembroke Welsh Corgi Club Inc for permission to adapt this application.