Corgi Rescue of Dayton, Ohio

"Forever Homes for Corgis"

~ Application To Adopt A Dog ~

Please scroll all the way to the bottom of the page first to see all the information you need to collect to fill out the form. You will need to scroll down the page as you go.

~ Personal Information ~
Your Full Name :
Please List the Names of All Persons in Your Home, Their Relationship to You, & Their Age.
Your Full Street Address, City, State, and Zip Code:
Your Telephone Numbers Including Area Code Home:
Work:
Cell:
Your Email Address :
A Vet Reference is REQUIRED To Process Your Application. Please Advise Your Vet That You Have Applied To Adopt A Rescue Dog And That We Will Be Calling Them For A Reference. We Will Schedule A Home Visit After Receiving A Recommendation From Your Vet. If You Do Not Have a Vet Because You Have No Pets, You Must Obtain Contact Info For the Vet You Plan to Use For Your New Pet.
Please Provide Your Vet's Name, Clinic/Business Name, City, and Address. (Required)
Your Vet's Phone Number Including Area Code: (Required)
1st of Three Non-Family Character References - Full Name:
1st of Three Non-Family Character References - Street Address:
1st of Three Non-Family Character References - Phone No.:
2nd of Three Non-Family Character References - Full Name:
2nd of Three Non-Family Character References - Street Address:
2nd of Three Non-Family Character References - Phone No.:
3rd of Three Non-Family Character References - Full Name:
3rd of Three Non-Family Character References - Street Address:
3rd of Three Non-Family Character References - Phone No.:
Is everyone in the family agreeable to getting a new pet?
How Would You Exercise Your Pet?
Your Occupation, Employer, and Length of Time Employed There:
Your Spouse's Occupation, Employer, and Length of Time Employed There:
If You Adopt A Dog From Us and We Find That You Are Not Meeting Our Standard In Caring For Him or Her, You Will Be Required To Return The Dog To Us At Your Expense Immediately. Do You Agree To This?	Yes  No
You agree that if you are no longer able to care for the dog that Corgi Rescue will be notified and the dog will be returned to the Rescue?	Yes  No
You Also Agree That if Issues Arise After You Have Taken the Dog into Your Home, that You Will Work with Corgi Rescue for at Least One Month to resolve These Issues Prior to Returning the Dog?	Yes  No
Excluding Death or Disability, What Other Circumstances Would Cause You To Dispose of A Dog That You Adopted From Us:
Are You Aware There Is An Adoption Donation For Each Dog In Our Rescue? Would You Like Us To Explain Why?	Yes  No
~ About Your Home and Yard ~
What Type of Home Do You Live In:	House  Apt  Town-House Condo  Mobile-Home
Do You Own or Rent Your Home?	Own  Rent
If You Rent, Does Your Written Lease Allow Pets?	Yes  No
Landlord Name and Phone Number (Required if You Rent):
Please Describe Fence and Yard, If You Have One. Is it Fenced? Is It Directly Accessible From Your Home?
If You Don't Have a Fenced Yard, Please Describe How the Dog Is To Be Exercised:
~ Other Animals ~
Have You Owned Any Dogs Or Cats That Are No Longer With You? How Many? Please explain what happened to them:	Yes  No
Do You Currently Own a Dog(s): Please List How Many, Breeds, and Ages.	Yes   No
Do You Currently Own a Cat(s)? If So, Please Describe How Many and Their Ages: If Other Type of Pet, Please Describe:	Yes   No
Were These Adopted From A Dog Pound/Shelter, taken In as Stray, Purchased, or a Gift:
In Which Dog(s) of Ours Are You Interested? ID Number? If No Particular Dog, Please Note Your Preferences Below, So We Can Let You Know When Such a Dog Becomes Available.
You Desire a Pure-bred dog, Mixed breed, or No Preference:	Pure  Mixed  No Preference
You Desire a Male, Female, or Either:	Female  Male  Either Sex
You Desire a Dog in What Age Range?
Please Name Three Traits You Are Looking for in Your New Companion:
Would You Adopt A dog With Special Needs? If You Would, Please Check Which Special Need(s) You Would Accept:	Blind  Deaf  Diabetic Epileptic  Arthritis  Allergies Daily Meds  Incontinent Cannot Climb Stairs Back Problems
What Type of Personality Are You Looking For In A Dog:
How Long Are You Willing To Wait For A Rescued Dog:
Please Allow One Week To Process Your Application. If You Do Not Hear From Us By Then, Please Call Us at 937-609-4707. Please click SUBMIT now. It Will Email Your Application to Us. If We Approve Your Application, We Will Require You To Sign An Adoption Contract.