| Date & Referral Source | |||||||
| State: | Date of Application: | 12/25/2018 | 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: |
0 months – 1 year (we rarely get dogs in this age group), 1 year – 3 years, 3 years – 5 years | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Energetic |
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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| 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? |
Our family | ||||||
Why do you want a Pembroke? |
We have owned large breed dogs in the past but have always been interested in corgis. We feel a smaller breed would better fit our current family since we now have children, and we love the playful and happy nature of corgis. We have done research and feel our country home and active family would be a great fit for a corgi. | ||||||
Activities planned with Pembroke: |
We would involve our dog in as many family activities as possible. We live in the country and spend a lot of time outside as well as visit the family cabin in the summer. We are also interested in exploring agility. | ||||||
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: |
We would attempt to correct the behavior and offer positive reinforcement. | ||||||
Discipline: |
We would use verbal correction and encourage positive behavior. | ||||||
Where would Pembroke spend the majority of the time: |
Inside our home with the family. | ||||||
Discipline: |
We would use verbal correction and encourage positive behavior. Where would Pembroke spend the majority of the time: Inside our home with the family. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Not typically. | ||||||
Where would dog eat? |
In our bedroom which is on the main level to keep the food dishes away from the kids. | ||||||
Where would dog sleep: |
In our bedroom and on our bed if they prefer. | ||||||
Play & exercise: |
In nicer weather we are often outside. We also have a large home with plenty of room for a dog to run and play inside. | ||||||
How will you exercise your dog? |
Both on leash and restrained to the yard | ||||||
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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: |
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: |
We own 5 acres set far back from the road. There is a shared pond about 50 yards from the house. | ||||||
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? |
Brian | ||||||
Willing to train children? |
Yes, we have purposefully waited until our children are old enough to listen and take direction before getting a family dog. | ||||||
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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? |
Yes, Pippin grew up with our two previous dogs for several years prior to them passing away. We would plan on slow introductions as well as providing both animals their own space. | ||||||
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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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