Adoption Application

CCR Kennels — Italian Cane Corso Breeder | Centralia, IL

Personal Information

Full Name *

Date of Birth *

Phone *

Email *

Street Address *

City *

State *

ZIP *

Housing Situation

Do you own or rent? *

Dwelling Type *

Fenced Yard? *

If yes, fence height?

If renting, landlord allows large dogs?

Household Members

Number of Adults *

Children in Household? *

Other Pets

Do you have other pets? *

Experience with Dogs

Owned a dog before? *

Owned a large breed dog?

Are you familiar with the Cane Corso breed? *

Puppy Preferences

Preferred Sex *

Preferred Color *

Intended Purpose *

References

Veterinarian Name

Veterinarian Phone

Personal Reference Name

Personal Reference Phone

Additional Information

How did you hear about CCR Kennels?

Why do you want a Cane Corso? *

Anything else you would like us to know?

Agreement & Electronic Signature

By submitting this application, I certify that:

1. All information provided in this application is true and accurate to the best of my knowledge.

2. I understand that submission of this application does not guarantee placement of a puppy.

3. I understand that CCR Kennels reserves the right to deny any application at their discretion.

4. I agree to provide a suitable, loving, and safe home for a CCR Kennels puppy.

5. I understand that a non-refundable $500 security deposit is required to reserve a puppy after application approval.

6. I agree to cooperate with CCR Kennels and provide any additional information requested during the review process.

7. I agree that CCR Kennels may contact my references for verification purposes.

I have read and agree to the terms above, and I certify all information is accurate. *

Electronic Signature *

Submission Date: April 2, 2026