| Date & Referral Source | |||||||
| State: | Date of Application: | 12/01/2018 | 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: |
1 year – 3 years | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful |
Other preferences: |
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| Dog Ownership History | |||||||
Previous dog owner? |
No | ||||||
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? |
For us in our home. | ||||||
Why do you want a Pembroke? |
We love their fun and goofy personalities and feel like they would be a good match for our life style. We have done research on the breed and understand that they require attention and activity, both of which we are willing and able to provide! We have minimal direct experience with the breed with the exception of a few Corgis that lived in our previous apartment building. | ||||||
Activities planned with Pembroke: |
We would take our Corgi on walks and play with him/her both inside our apartment and outside in our yard (we live in a two-flat). We would love to spend time relaxing with the dog around the house. We enjoy outdoor activity (e.g. hiking in forest preserves, spending time in local parks) in the warmer months and are looking forward to have a companion. We even dream of bring him/her with us down to our lake house in Tennessee. | ||||||
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? |
No | ||||||
Vet contact info: |
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Will handle mistakes Pembroke makes like this: |
Calmly tell the dog "no" using simple language and few words. Crating is not a form of punishment. Instead, I will show the dog what was not acceptable and use positive re-enforcement to train the dog to avoid the mistake in the future. | ||||||
Discipline: |
Scolding, verbal "no"s, | ||||||
Where would Pembroke spend the majority of the time: |
Inside at home. Free reign of all rooms when owners are home. Crated while owners are not home. | ||||||
Discipline: |
Scolding, verbal "no"s, Where would Pembroke spend the majority of the time: Inside at home. Free reign of all rooms when owners are home. Crated while owners are not home. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Sometimes but not always. I work full-time and my wife works part-time currently. Therefore, someone would be around most afternoons, but there would be periods during the day where the dog would be alone. | ||||||
Where would dog eat? |
Kitchen and/or crate depending on the dog's preference. | ||||||
Where would dog sleep: |
2nd Bedroom in crate. | ||||||
Play & exercise: |
We will provide daily exercise and walks with extended outdoor time in the warmer months of the year. | ||||||
How will you exercise your dog? |
On leash | ||||||
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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? |
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Living arrangements: |
Rent/lease home | ||||||
Landlord info: |
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May we contact your landlord? |
Yes, you may contact my landlord. | ||||||
Lease allow dogs: |
Yes, my lease permits dogs. | ||||||
Landlord permission: |
Yes, my landlord is fine with me owning a Pembroke | ||||||
Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
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Description of yard: |
Grass yard with a concrete and brick patio. Partially fenced. | ||||||
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? |
Alyssa | ||||||
Willing to train children? |
Yes, but we do not have children nor are they expected in the near future. | ||||||
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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? |
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Are you willing to work on it if your new dog doesn’t get along with your current pets right away? |
N/A – do not plan to have any other pets. | ||||||
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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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