| Date & Referral Source | |||||||
| State: | Date of Application: | 11/29/2017 | Referred by: | Website, Friend | |||
| 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: | 1 year – 3 years, 3 years – 5 years | Gender preferred: | Female | Color preferred: | Red & White | Activity level: | Couch Potato, Outgoing, Quiet, Playful, Energetic | 
| Other preferences: | I have one 5 year old Shih Tzu who is a couch potato.. I will require any dog to need to be able to get along with her. | ||||||
| Dog Ownership History | |||||||
| Previous dog owner? | Yes | ||||||
| Dog 1 | |||||||
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| Dog 2 | |||||||
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| Questions Regarding Motivation for Adopting and Intentions | |||||||
| Who is this dog for? | The Pembroke is for myself, Andrew Primeau. | ||||||
| Why do you want a Pembroke? | I've known about Corgi's for years because of it's associations with Queen Elizabeth II. Eventually, I decided to research the breed itself and fell in love with the breed in it's own right. I love their playfulness and attachment to their owners. My family pet growing up was a newfoundland who was rather lazy, I would like a companion in my corgi. I've been researching corgi's for the better part of three years now. | ||||||
| Activities planned with Pembroke: | Walks, playing, and just being together. Possibly swimming…. My family extended occasionally brings our dogs together when we go to our summer house in northern Michigan. The breeds include a rescued Siberian Husky and my Shih Tzu Stella that I mentioned earlier. | ||||||
| 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 usually make a "Tch" sound to break their focus on their bad behavior and distract them to a new activity. Dogs need a calm and focused response. | ||||||
| Discipline: | I usually make a "Tch" sound to break their focus on their bad behavior followed by a stern "No __dog name__" then distract them to a new activity. If the mistake continues some time in pen to calm the dog can also be used. | ||||||
| Where would Pembroke spend the majority of the time: | With the family on the main floor we usually are. | ||||||
| Discipline: | I usually make a "Tch" sound to break their focus on their bad behavior followed by a stern "No __dog name__" then distract them to a new activity. If the mistake continues some time in pen to calm the dog can also be used. Where would Pembroke spend the majority of the time: With the family on the main floor we usually are. | ||||||
| House dog or outside dog? | House dog | ||||||
| People at home during the day? | My mother and I have alternating shifts so someone is home at all times. My sister is also in high school and is home every day after 2p. | ||||||
| Where would dog eat? | We feed our Shih Tzu Iams dog food. I would be willing to get whatever brand is recommended. | ||||||
| Where would dog sleep: | I would prefer my dog to sleep with me or in his dog bed/crate. | ||||||
| Play & exercise: | The corgi will get at least two walks 20-30 minute walk per day. We keep plenty of toys for the Shih Tzu and play with her for at least 30-40min per day. | ||||||
| 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? | Chain link fence. | ||||||
| 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: | We have about a half acre sized yard with three trees and a large wooden deck. The fence encircles the yard to keep it enclosed. Have an above ground swimming pool with a ladder to get in. There is no way for a dog to get into the pool. | ||||||
| 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? | Andrew Primeau | ||||||
| Willing to train children? | I have no children and will not be having any. But if by some miracle one dropped out of the sky, Yes I would be more than happy to. | ||||||
| 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 I am. | ||||||
| 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: | |||||||