Norfolk Terrier Club Adoption Application This is an application for adoption of a Norfolk Terrier. Enter the Date and complete the all the fields before submitting your Application for review. MM slash DD slash YYYY Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneCheck this box if Texting is Okay. Texting OK Enter best time to call. Email My Preferences; Why do you want in a Norfolk?I like a dog who is... Check the options you prefer and if needed explain further in the additional preference box below. High Energy Lap Dog Additional Preference ExplanationAbout me and my Household... I have owned a Terrier before. I have a fenced yard. i will walk on a lease. I share my home with Adults. Enter the number of Adults.Please enter a number from 0 to 100.I share my home wit Children. Enter the number and ages of the children. Someone in my house is unsure of dogs. Explain... Someone in my house is allergic to dog dander. Explain... Other Pets (including birds, guinea pigs, hamsters, etc.) sex and age.I need a dog that will be okay home alone for a number of hours. Enter the number below.Just a few more questions... I enjoy grooming. I will have it groomed. I would like to take my dog in the car. I would walk my dog often. Where will your dog spend the day? Dog House Kennel/Run indoors (crated) Basement Your room Fenced yard Loose indoors Have you ever owned a Norfolk Terrier and if yes, where did you get it? Are you a member of the NTC or ANTA? Check if applicable. NTC Norfolk Terrier Club ANTA American Norfolk Terrier Association Veterinarian I will be using. Enter name, address and phone number.May we verify your references with the vet Yes No Bad habits I cannot tolerate are...My ideal dog would be...Please tell us anything about yourself or the dog you are looking for...Is there anything you want to add?You agree to the terms and conditions of this application. The Applicant acknowledges that the adoption process is not complete until the Norfolk Terrier Rescue adoption process is fully executed.(Required) Yes Date of terms and conditions acceptance. Clicking the Submit button below will send your application for review. MM slash DD slash YYYY
