Date & Referral Source | |||||||
State: | Date of Application: | 10/08/2017 | Referred by: | Website | |||
Contact Information | |||||||
First name: | Last name: | First name 2: | Last name 2: | ||||
Address | |||||||
Street: | |||||||
City: | State: | Zip: | |||||
Type of Dog Wanted | |||||||
Ages interested in: |
0 months – 1 year (we rarely get dogs in this age group) | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Outgoing, Playful, Energetic |
Other preferences: |
Would consider an older corgi (age 1-3 years) if already house & obedient trained | ||||||
Dog Ownership History | |||||||
Previous dog owner? |
Yes | ||||||
Dog 1 |
|||||||
Dog 1 name: |
|||||||
Dog description: |
|||||||
How long owned? |
|||||||
Where is this dog now? |
|||||||
Dog 2 | |||||||
Dog 2 name: |
|||||||
Dog description: |
|||||||
How long owned? |
|||||||
Where is the dog now? |
|||||||
Dog 3 | |||||||
Dog 3 name: |
|||||||
Dog description: |
|||||||
How long owned? |
|||||||
Where is dog now? |
|||||||
Dog 4 | |||||||
Dog 4 name: |
|||||||
Dog description: |
|||||||
How long owned? |
|||||||
Where is this dog now? | |||||||
Questions Regarding Motivation for Adopting and Intentions | |||||||
Who is this dog for? |
Myself & my husband, Norman | ||||||
Why do you want a Pembroke? |
I have done some research on the breed, I love the personalities of the corgis, love their look, characteristics and feel this breed of dog would fit into mine & my husbands life style at this time in our lives (I'm 53, he's 70) we've had many dogs in our family and our last dog, a mini dauschand, passed away about 5 years ago and we really miss her, she was 17 years old and we got her the day she turned 6 weeks old! | ||||||
Activities planned with Pembroke: |
Walking, playing on my 5 acres, fetch, I have 2 grandkids, ages 5 & 9 and a new one on the way so they will help me keep the corgi very active! 😄 | ||||||
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: |
Proper obedience training | ||||||
Discipline: |
Verbal commands and dog/owner training | ||||||
Where would Pembroke spend the majority of the time: |
In the house, with me & my husband | ||||||
Discipline: |
Verbal commands and dog/owner training Where would Pembroke spend the majority of the time: In the house, with me & my husband |
||||||
House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes | ||||||
Where would dog eat? |
In the pantry area of my home | ||||||
Where would dog sleep: |
Probably in a crate | ||||||
Play & exercise: |
They would be exercised EVERY day! I have 5 acres of land so many opportunities for exercise here! Or there are many hiking trails and parks we can take them to | ||||||
How will you exercise your dog? |
Both on leash and restrained to the yard | ||||||
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? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
Plan on getting an above ground pool next spring, do not currently have a fenced area on my 5 acres at this time, but WILL put a fence up for a dog | ||||||
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? |
Sherry Broussard | ||||||
Willing to train children? |
Absolutely! | ||||||
Any allergies? |
No one is allergic. | ||||||
Current pets: |
|||||||
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, the dogs listed above only visit occasionally, when our daughter brings them over, they don't live with us, but they are friendly dogs who get along with other dogs | ||||||
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: |