C-Myste Corgis – Carolyn Cannon

Baledwr Corgis – Mandy Katasse

This questionnaire is designed to help assist us in making the successful placement of a puppy. It supplies us with information about your lifestyle, experience, and goals as a potential Cardigan owner. Please fill out the questionnaire in its entirety with as much information as you can provide.

*(denotes required field)

Name(s):*

E-Mail Address:*

Street Address

Mailing Address (if different)

Telephone

Occupation(s) and employers

Will this be your first Cardigan Welsh Corgi?

Yes No

If so, what has drawn you to the breed?

Have you lived with a Cardigan or other herding breed before?

Yes No

Describe the characteristics of your "perfect dog":

Do you prefer a male or a female, and why?

Do you have any color or coat preferences?

(We sometimes have "fluffy" puppies, who have a more profuse and softer coat)

What are your favorite hobbies?

Describe your living situation: own/rent, single-family, or apartment, lot size, etc:

If you rent does your lease allow dogs or does your landlord know and approve?

Yes No N/A

Are there any restrictions from a Homeowners Association?

Yes No N/A

Landlord's/HOA name and e-mail or phone number if applicable:

Do you have a fenced yard or dog area? If so, how tall is the fence and how large is the area?

List all household members. If children are included in your family, please list age and gender of each.

Are all of the members of the household in agreement about acquiring a Cardigan?

Yes No

Do any of your family members have allergies? (Describe)

List other pets or animals you have (species, breed, age, sex):

What other pets have you had in the past?

Who will have primary responsibility for care?

Feeding?

Grooming?

Walking?

Where will the puppy spend his/her days?

Where will the puppy spend his/her nights?

How will the puppy ride in your vehicle?

Have you ever trained or shown a dog in obedience, agility, conformation, or other activities? (Describe)

What activities might you be interested in pursuing with your Cardigan?

(Examples: Obedience, Herding, Tracking, Agility, Conformation shows, Breeding, Therapy, Hiking, Houshold companion)

Are you or have you been a member of any dog clubs or organizations? (please list)

Personal references (e-mail preferred, or telephone):

Veterinary reference:

May we or a representative visit your home?

Yes No

How far are you wiling to drive for a puppy? If distant, would you be willing to fly to pick him or her up?

I hereby certify that all the information contained in this application is true and correct. This application is not an agreement to buy or sell a puppy but is a tool to aid in the placement of a puppy. No actual sale will be considered final until a bill of sale and contract is signed by and delivered to both parties.

Signature (type name)

Date:

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