| Date & Referral Source | |||||||
| State: | Date of Application: | 02/04/2019 | Referred by: | Website | |||
| Contact Information | |||||||
| First name: | Last name: | First name 2: | Last name 2: | ||||
| Address | |||||||
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| 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 |
Other preferences: |
My son is going to be 5, we currently have a Bernese Mountain dog and a cat that has no problem with our dog. | ||||||
| Dog Ownership History | |||||||
Previous dog owner? |
Yes | ||||||
Dog 1 |
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Dog 1 name: |
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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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| 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 | |||||||
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Who is this dog for? |
My son and I are looking to add another addition to our family. I recently purchased our first home and we are looking to get our Bernese Mountain dog a sibling. | ||||||
Why do you want a Pembroke? |
I love the way they look and everything I've researched about them shows me they make great family dogs. I have not had this breed before, but am looking to have a small dog that I can cuddle with. | ||||||
Activities planned with Pembroke: |
I would like to take him/her to parks, on walks, and on vacation with our family. I would also like him/her to be a good sibling to our current dog, Chewbacca. I would like to watch them play together and run around the backyard! | ||||||
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: |
I would verbally correct him/her, and show him/her what to chew on or where to go afterwards. | ||||||
Discipline: |
Verbally correct them, and redirect them with the appropriate place/behavior | ||||||
Where would Pembroke spend the majority of the time: |
Free range of our house. Unless it is a puppy, then I would put him in a larger cage to stay in for a few hours while I am at work, since it would be potty training. | ||||||
Discipline: |
Verbally correct them, and redirect them with the appropriate place/behavior Where would Pembroke spend the majority of the time: Free range of our house. Unless it is a puppy, then I would put him in a larger cage to stay in for a few hours while I am at work, since it would be potty training. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
1-2 | ||||||
Where would dog eat? |
in the kitchen with his/her own bowl | ||||||
Where would dog sleep: |
In my bed or on a dog bed next to my bed | ||||||
Play & exercise: |
I have a large backyard he/she could play in, and also currently take my Berner for walks when the weather is appropriate. During the warmer months, we also go to the dog park. When in the house, we use different toys to play fetch or tug of war. | ||||||
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: |
I currently do not have any fixtures in my yard and I am waiting on the warmer months to put a fence in. | ||||||
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? |
Tracie Ball | ||||||
Willing to train children? |
My son currently helps me take care of our Berner, cat, fish and turtle. He understands that you do not hit animals or yell at them (unless you're verbally correcting them). He is looking forward to the day we can get another 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. | ||||||
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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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