| Date & Referral Source | |||||||
| State: | Date of Application: | 08/26/2017 | Referred by: | Other | |||
| Contact Information | |||||||
| First name: | Last name: | First name 2: | Last name 2: | ||||
| Address | |||||||
| Street: | |||||||
| City: | State: | Zip: | |||||
| Type of Dog Wanted | |||||||
Ages interested in: |
1 year – 3 years, 3 years – 5 years, 5 years – 10 years | Gender preferred: |
Female | Color preferred: |
Red Headed Tri | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Energetic, Very Active |
Other preferences: |
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| Dog Ownership History | |||||||
Previous dog owner? |
Yes | ||||||
Dog 1 |
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Dog 1 name: |
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Dog description: |
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How long owned? |
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Where is this dog now? |
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| Dog 2 | |||||||
Dog 2 name: |
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Dog description: |
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How long owned? |
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Where is the dog now? |
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| Dog 3 | |||||||
Dog 3 name: |
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Dog description: |
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How long owned? |
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Where is dog now? |
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| Dog 4 | |||||||
Dog 4 name: |
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Dog description: |
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How long owned? |
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| Where is this dog now? | |||||||
| Questions Regarding Motivation for Adopting and Intentions | |||||||
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Who is this dog for? |
http://www.clarkeanimalhospital.net/ Rosalind and Robert Mayberry |
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Why do you want a Pembroke? |
We have had dogs all of our lives, both of us as in our growing up families and we have always had dogs in our married life together. Our last 2 dogs were corgis, the most recent from Lakeshore Corgi Rescue. Corgis are magical–loving, smart, funny, hard working, helpful. I believe I have read almost everything written on these amazing creatures. | ||||||
Activities planned with Pembroke: |
Play, walk, cuddle, talk to, read to, sing to, find jobs for… | ||||||
Aware that Pembrokes are busy, noisy dogs? |
Yes | ||||||
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Money for basic care? |
Yes | ||||||
Money for unforeseen medical expenses? |
Yes | ||||||
Willing to house train? |
Yes Willing to do formal training? Yes |
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Do you have a veterinarian? |
Yes | ||||||
Vet contact info: |
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Will handle mistakes Pembroke makes like this: |
I have found that a stern quiet "no" has always worked for me. I hate to use the crate for time out because both of our corgis seemed to think the crate was their "space." | ||||||
Discipline: |
Firm, quiet voice only. | ||||||
Where would Pembroke spend the majority of the time: |
In the house with us. We do have an enclosed dog yard, but usually I stay outside with her or leave the door into the yard pen so she can come or go as she pleases. | ||||||
Discipline: |
Firm, quiet voice only. Where would Pembroke spend the majority of the time: In the house with us. We do have an enclosed dog yard, but usually I stay outside with her or leave the door into the yard pen so she can come or go as she pleases. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes | ||||||
Where would dog eat? |
in the crate with the door open | ||||||
Where would dog sleep: |
First corgi slept on the foot of the bed. Most recent corgi did not like to. She slept on the floor right beside the bed or in a lounge chair in the bedroom. Sometimes in the day she went into her crate to sleep | ||||||
Play & exercise: |
Frequent daily walks on the leash. Several sessions of tossing and pulling everyday. | ||||||
How will you exercise your dog? |
Both on leash and restrained to the yard | ||||||
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Fenced yard? |
Yes, I have a fenced in yard. | ||||||
Willing to pick up dog waste? |
Yes, I will clean up after my dog. | ||||||
Willing to use a crate? |
A large rectangular area along the length of the house with the back door inside the fenced in area, about 4-1/2' high, sturdy fencing. | ||||||
Living arrangements: |
Own home | ||||||
Landlord info: |
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May we contact your landlord? |
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Lease allow dogs: |
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Landlord permission: |
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Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
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Description of yard: |
Large corner lot with wild flower garden and trees at the back, side yard fenced in for dog. | ||||||
Household members: |
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Everyone in household agrees about adopting a corgi? |
Yes, everyone agrees and wants to adopt a Pembroke Welsh Corgi. | ||||||
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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? |
Rosalind Mayberry | ||||||
Willing to train children? |
Yes. of course, but we do not have young children nor do we have grandchildren but I always take time with children to teach them how to be gentle with animals. | ||||||
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Any allergies? |
One or more family members might be allergic to dogs. | ||||||
Current pets: |
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Current pets dog friendly? |
Yes, all of our current pets are friendly toward dogs. | ||||||
Are you willing to work on it if your new dog doesn’t get along with your current pets right away? |
Yes, of course. We do not have other pets, although our daughter and her husband's Golden Doodle, Lucy, is frequently at our house in the evening when they are working. | ||||||
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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. | ||||||
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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: |
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