Thank you for your interest in Mayflower PWCC Corgi Rescue. Please complete this form as completely as possible. There are no wrong answers! We are trying to get a snapshot into what sort of dog might best fit your lifestyle and home. Answers with a RED ASTERISK require an answer.

If you cannot answer, please type NA into that particular box.

APPLICANT INFORMATION

First Name *

Last Name *

Date Submitted * +

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Best Time To Call *

Email Address *

ADULT(S) IN YOUR HOUSEHOLD * 🛈

	NAME & AGE	OCCUPATION	HOBBIES/ACTIVITIES
YOU	NAME & AGE	OCCUPATION	HOBBIES/ACTIVITIES
OTHER	NAME & AGE	OCCUPATION	HOBBIES/ACTIVITIES
OTHER	NAME & AGE	OCCUPATION	HOBBIES/ACTIVITIES

CHILDREN IN YOUR HOUSEHOLD 🛈

	NAME	AGE	ACTIVITIES
NAME	NAME	AGE	ACTIVITIES
NAME	NAME	AGE	ACTIVITIES
NAME	NAME	AGE	ACTIVITIES
NAME	NAME	AGE	ACTIVITIES

CHARACTERISTICS DESIRED IN A PWC

DESIRED PEMBROKE CHARACTERISTICS *

AGE RANGE

SEX/COLOR

MALE
FEMALE
NO PREFERENCE

WOULD YOU CONSIDER MORE THAN ONE DOG? *

YES

NO

POSSIBLY

WOULD YOU CONSIDER A DOG WITH MANAGEABLE HEALTH ISSUES? *

YES Special Diet	YES Medication
YES Surgery	NO

WOULD YOU CONSIDER A DOG THAT REQUIRES BEHAVIORAL TRAINING? (separation anxiety, fear aggression, etc)? *

YES

NO

CHOOSE THE TOP 5 ATTRIBUTES IN ORDER OF IMPORTANCE, 5 IS MOST IMPORTANT 1 IS LEAST:

	OBEDIENT
	PLAYFUL
	EASY GOING
	ENERGETIC
	ATHLETIC
	CALM
	OUTGOING
	QUIET
	AFFECTIONATE
	HOUSETRAINED
	GOOD IN CAR
	GOOD WITH CHILDREN
	GOOD WITH DOGS
	GOOD WITH CATS
	WALKING/HIKING
	GOOD ON LEASH
	FOR CANINE SPORTS

LIVING SITUATION

DESCRIBE THE TYPE OF HOME SITUATION YOU LIVE IN 🛈

NEIGHBORHOOD SETTING

URBAN/CITY

SUBURBAN/SIDEWALKS

SUBURBAN/NO SIDEWALKS

RURAL

DO YOU OWN OR RENT? *

OWN

RENT* If you rent please be able to provide proof of permission from landlord

IS THERE A FENCED YARD *

YES the yard is physical fence

YES the yard has underground fence

YES the yard is partially fenced

NO the yard is not fenced

NO we do not have a yard

PLEASE DISCUSS THE AMOUNT AND TYPE OF EXERCISE YOU WILL GIVE THE DOG *

0/500 characters

ARE THERE NEIGHBORHOOD CHILDREN/GRANDCHILDREN/THAT MAY VISIT THE HOME? MIGHT YOU HAVE CHILDREN IN FUTURE? *

ANIMAL EXPERIENCE

ARE THERE DOGS NEXT DOOR/NEARBY? * 🛈

NO

YES YES

ARE ANY HOUSEHOLD MEMBERS ALLERGIC? *

YES

NO

PLEASE DESCRIBE HOW AND WHY YOU BECAME INTERESTED IN A PEMBROKE WELSH CORGI? *

PLEASE DESCRIBE ANY PAST EXPERIENCE WITH CORGIS

PLEASE DESCRIBE ANY PAST/PRESENT EXPERIENCE WITH DOG OWNERSHIP/TRAINING *

WHO WOULD BE PRIMARILY RESPONSIBLE?

WHERE WILL THE DOG STAY?

WHAT IS THE AVERAGE AMOUNT OF TIME/DAY THE DOG WOULD BE ALONE?

WILL SOMEONE BE HOME DURING THE DAY *

YES

NO

WHERE WILL YOUR DOG EAT?

DESCRIBE HOW YOU ENVISION EXERCISING THE DOG ON A WORKDAY

DO YOU PLAN TO ENROLL IN A TRAINING CLASS? *

YES

NO

HAVE YOU TRAINED A DOG PREVIOUSLY? * 🛈

NO

YES YES

WHAT ARRANGEMENTS CAN YOU MAKE FOR THE DOG WHEN YOU TRAVEL?

EVEN WITH THE BEST OF TRAINING AND CARE, A DOG MAY REVERT IN ITS BEHAVIOR AND TRAINING WHEN PLACED IN A NEW AND STRANGE SITUATION. THEY MAY LOSE THEIR HOUSETRAINING, MAY BECOME FEARFUL, MAY BECOME SHY OR DESTRUCTIVE. WOULD YOU BE ABLE AND WILLING TO PROVIDE PROPER TRAINING IN SUCH SITUATIONS AND SEEK ASSISTANCE *

YES

NOT SURE

NO

EXISTING PETS

DO YOU HAVE ANY OTHER PETS AT THIS TIME? *

YES (PLEASE COMPLETE NEXT QUESTION)

NO

OTHER PETS IN HOME (EVEN PART TIME!) 🛈

	PET 1	PET 2	PET 3	PET 4
SPECIES (dog/cat/bird/reptile/rodent)	PET 1	PET 2	PET 3	PET 4
BREED	PET 1	PET 2	PET 3	PET 4
PERSONALITY	PET 1	PET 2	PET 3	PET 4
AGE	PET 1	PET 2	PET 3	PET 4
SEX (m/f)	PET 1	PET 2	PET 3	PET 4
NEUTERED (y/n)	PET 1	PET 2	PET 3	PET 4
VACCINATED (y/n)	PET 1	PET 2	PET 3	PET 4

HOW DOES THE PET(S) BEHAVE AROUND NEW DOGS?

HAVE YOU OWNED A DOG BEFORE? * 🛈

NO

YES YES

HAVE YOU EVER ADOPTED FROM A RESCUE/SHELTER BEFORE? 🛈

NO

YES YES

PLEASE DISCUSS YOUR AND YOUR FAMILY MEMBERS' OVERALL EXPERIENCE WITH DOGS:

WHAT SITUATION, IF ANY, WOULD CAUSE YOU TO SURRENDER A FAMILY PET?

REFERENCES

REFERENCE 1 NAME:

RELATIONSHIP TO YOU:

Street Address

Address Line 2

City

State

Zip Code

Phone Number

Email Address

REFERENCE 2 NAME:

RELATIONSHIP TO YOU:

Street Address

Address Line 2

City

State

Zip Code

Phone Number

Email Address