| Date & Referral Source | |||||||
| State: | Date of Application: | 08/24/2017 | Referred by: | Website | |||
| Contact Information | |||||||
| First name: | Last name: | First name 2: | Last name 2: | ||||
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| City: | State: | Zip: | |||||
| Type of Dog Wanted | |||||||
| Ages interested in: | 0 months – 1 year (we rarely get dogs in this age group), 1 year – 3 years, 3 years – 5 years, 5 years – 10 years, 10 years +, Any age | Gender preferred: | Either a Male or a Female | Color preferred: | Red & White, Red Headed Tri | Activity level: | Couch Potato, Outgoing, Quiet, Playful, Energetic, Very Active | 
| Other preferences: | |||||||
| Dog Ownership History | |||||||
| Previous dog owner? | No | ||||||
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| Dog 2 | |||||||
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| Dog 3 | |||||||
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| Dog 4 | |||||||
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| Questions Regarding Motivation for Adopting and Intentions | |||||||
| Who is this dog for? | My mother and myself. | ||||||
| Why do you want a Pembroke? | I love the friendly and intelligent nature of the dog. Having encountered a neighbor's Corgi, I was struck by its beautiful coat and its surprisingly levels of energy. I know that Corgis require a great deal of attention and affection. I am ready to match its levels of high energy by walking with it as much as necessary. | ||||||
| Activities planned with Pembroke: | Daily walks during the day and night. Occasionally running around the dog park. Training it to handle its bark and curiosity. | ||||||
| Aware that Pembrokes are busy, noisy dogs? | Yes | ||||||
| Money for basic care? | Yes | ||||||
| Money for unforeseen medical expenses? | Yes | ||||||
| Willing to house train? | Yes Willing to do formal training? Yes | ||||||
| Do you have a veterinarian? | No | ||||||
| Vet contact info: | |||||||
| Will handle mistakes Pembroke makes like this: | I wouldn't discipline it, but rather reward positive behavior. If in the middle of a negative behavior, I would clap loudly to distract it. | ||||||
| Discipline: | Positive reinforcement is ideal. Trying to associate negative behavior with a negative action. | ||||||
| Where would Pembroke spend the majority of the time: | Inside the house, but with free roam of the area. | ||||||
| Discipline: | Positive reinforcement is ideal. Trying to associate negative behavior with a negative action. Where would Pembroke spend the majority of the time: Inside the house, but with free roam of the area. | ||||||
| House dog or outside dog? | House dog | ||||||
| People at home during the day? | Yes there are, as my mother will soon be retiring. | ||||||
| Where would dog eat? | In the kitchen, with a special food and water bowl. | ||||||
| Where would dog sleep: | In a pet bed, most likely near one of our adult beds. | ||||||
| Play & exercise: | My mother and I take daily walks at night, so this is a great opportunity to bring it along for exercise. I will take our Corgi to the dog park on occasion, making sure that it has the ability to run around a fenced area. I will make sure to satisfy our dogs energy needs. | ||||||
| How will you exercise your dog? | On leash | ||||||
| Fenced yard? | No, I don’t have a fenced in yard. | ||||||
| Willing to pick up dog waste? | Yes, I will clean up after my dog. | ||||||
| Willing to use a crate? | |||||||
| Living arrangements: | Own home | ||||||
| Landlord info: | |||||||
| May we contact your landlord? | |||||||
| Lease allow dogs: | |||||||
| Landlord permission: | |||||||
| Restrictive covenants? | No, the condo covenants do not prevent me from having a dog. | ||||||
| Breed/size restrictions? | No | ||||||
| Description of yard: | I live in a townhouse, unfortunately this doesn't include a yard. | ||||||
| Household members: | |||||||
| Everyone in household agrees about adopting a corgi? | Yes, everyone agrees and wants to adopt a Pembroke Welsh Corgi. | ||||||
| May we do a home visit? | Yes, I will allow LPWCR representatives to inspect my home prior to allowing me to adopt a Pembroke. | ||||||
| Who will be responsible for the adopted corgi’s care? | Daniel Bai | ||||||
| Willing to train children? | Not applicable, as there are no children in the household for the foreseeable future | ||||||
| Any allergies? | No one is allergic. | ||||||
| Current pets: | |||||||
| Current pets dog friendly? | |||||||
| Are you willing to work on it if your new dog doesn’t get along with your current pets right away? | Not Applicable. | ||||||
| Lifetime commitment to Pembroke? | Yes, I am willing to commit to this dog for the rest of its life. | ||||||
| Return to Lakeshore if unable to care for Pembroke? | Yes, I will only surrender my adopted corgi to LPWCR if I am unable to care for it. | ||||||
| Understand no guarantees? | Yes, I understand that there are no guarantees regarding the condition, health, behavior or personality of the Pembroke I adopt. | ||||||
| Carefully considered the pluses and minuses of adopting a pet? | Yes, I have carefully thought out my decision to adopt a Pembroke and am willing to deal with the consequences. | ||||||
| Personal references: | |||||||