Date & Referral Source | |||||||
State: | Date of Application: | 11/05/2017 | Referred by: | Friend | |||
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 | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Playful |
Other preferences: |
I,have raised puppies, but prefer a dog who is house trained. I also use crate training so that,workmen can enter our house without dog interference. | ||||||
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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Questions Regarding Motivation for Adopting and Intentions | |||||||
Who is this dog for? |
Me and my 3 year old male Labradoodle, Charlie | ||||||
Why do you want a Pembroke? |
I have met Corgis and have been I,pressed with their confidence and composure. | ||||||
Activities planned with Pembroke: |
Daily walks on our,private road and days at a dog park. Trips in the car with Charlie and me. | ||||||
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 |
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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 would show the dog what is OK behavior and reinforce with a treat or praise. | ||||||
Discipline: |
I would try to focus attention on a positive activity instead of the destructive behavior. Positive reinforcement is more successful than negatives like saying bad dog. Usually the behavior has ended and the dog does not understand why a scolding is being given. | ||||||
Where would Pembroke spend the majority of the time: |
Charlie has free run of the house in cold weather. Dogs have access to outside during the milder months of the year. | ||||||
Discipline: |
I would try to focus attention on a positive activity instead of the destructive behavior. Positive reinforcement is more successful than negatives like saying bad dog. Usually the behavior has ended and the dog does not understand why a scolding is being given. Where would Pembroke spend the majority of the time: Charlie has free run of the house in cold weather. Dogs have access to outside during the milder months of the year. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
I am here most days except for a couple of classes during the week. Usually not gone more than 2 to 3 hours per day. | ||||||
Where would dog eat? |
The dogs eat in our casual dining area where I dine myself. | ||||||
Where would dog sleep: |
I have dog bed for my current pooch and the Corgi would have a bed too. I prefer they not sleep on my bed. | ||||||
Play & exercise: |
I walk Charlie twice per day a few street blocks. They have access to our fenced backyard for informal play. Also go to dog parks several times per week. | ||||||
How will you exercise your dog? |
Both on leash and restrained to the yard | ||||||
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? |
I have 2" x 4" wire mesh fence which is 48" high. | ||||||
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 | ||||||
Description of yard: |
We have an inground swimming pool in a fenced yard. Dogs are trained not to go in the pool. It is covered with safety mesh in winter and features stair out should a dog fall in accidentally. Am willing to purchase an alarm if the dog is not trained to stay out of the pool.. | ||||||
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. | ||||||
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? |
June Paynter | ||||||
Willing to train children? |
No children in my household. Great niece, age 5, has grown up with dogs as have step niece and nephew. | ||||||
Any allergies? |
No one is allergic. | ||||||
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? |
I would like Charlie's trainer to meet any candidate dog and access suitability. Yes. | ||||||
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: |