| Date & Referral Source | |||||||
| State: | Date of Application: | 01/31/2019 | 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 | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Outgoing, Playful, Energetic |
Other preferences: |
We do have a cat so we need a dog that gets along with cats. | ||||||
| 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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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? |
My family | ||||||
Why do you want a Pembroke? |
My family loves the breed. We owned a pembroke for 13 years but sadly she passed over the rainbow bridge at christmas time 2018. We love the playful, energy or the pembroke welsh corgi. | ||||||
Activities planned with Pembroke: |
I have 2 kids ages 7 and 12. We would go on walks, play ball, go to dog parks, and friends who have dogs too. We have a nice walking path by our house and a dog friendly park near by where we would go for walks too. | ||||||
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: |
In a firm voice say NO then redirect the behavior to an act we prefer. | ||||||
Discipline: |
Positive reinforcement with firm voice commands of NO and redirection in times of misbehavior. | ||||||
Where would Pembroke spend the majority of the time: |
In our house | ||||||
Discipline: |
Positive reinforcement with firm voice commands of NO and redirection in times of misbehavior. Where would Pembroke spend the majority of the time: In our house |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Most of the time. We we are not home we will kennel the dog. If we are gone for long periods of time we do have a neighbor with a key that will come and spend time with the dog and take him/her for a walk and play. | ||||||
Where would dog eat? |
In a designated area of our house near the kitchen. | ||||||
Where would dog sleep: |
Probably in a kennel at first, until we can learn to trust the dog. Then probably with our son in his bedroom or in our bedroom. | ||||||
Play & exercise: |
We have walking paths by our house, plus a nice dog friendly park near by as well. We also have friends with dogs we can socialize with too. He/she will get daily play and exercise | ||||||
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: |
townhome | ||||||
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 live in a townhome with a large common area and nice walking paths. We also live close to a park that is friendly toward dogs. Because we can not have a fence we will have a long 20 ft tether leash for outside, but the dog will never be outside without someone with someone to supervise. | ||||||
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? |
Jessica Folsom | ||||||
Willing to train children? |
Yes, my have been around dogs and cats their whole life and know how to humanely treat animals. | ||||||
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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 | ||||||
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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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