| Date & Referral Source | |||||||
| State: | {Applicant State:2} | Date of Application: | 02/12/2019 | Referred by: | Website | ||
| Contact Information | |||||||
| First name: | {First Name:98} | Last name: | {Last Name:97} | First name 2: | {First Name 2:94} | Last name 2: | {Last Name 2:93} |
| Address | |||||||
| Street: | {Street Address:3} | ||||||
| City: | {City:4} | State: | {State:5} | Zip: | {Zip:6} | ||
| Type of Dog Wanted | |||||||
Ages interested in: |
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 |
|||||||
Dog 1 name: |
{Dog Name (Most recent/ current first):24} | ||||||
Dog description: |
{Description of Dog:25} | ||||||
How long owned? |
{Length of time owned:26} | ||||||
Where is this dog now? |
{Where is this dog now? (Explain if you no longer have the dog):37} | ||||||
| Dog 2 | |||||||
Dog 2 name: |
{Dog Name (Most recent/ current first):30} | ||||||
Dog description: |
{Description of Dog:33} | ||||||
How long owned? |
{Length of time owned:35} | ||||||
Where is the dog now? |
{Where is this dog now? (Explain if you no longer have the dog):39} | ||||||
| Dog 3 | |||||||
Dog 3 name: |
{Dog Name (Most recent/ current first):29} | ||||||
Dog description: |
{Description of Dog:32} | ||||||
How long owned? |
{Length of time owned:36} | ||||||
Where is dog now? |
{Where is this dog now? (Explain if you no longer have the dog):27} | ||||||
| Dog 4 | |||||||
Dog 4 name: |
{Dog Name (Most recent/ current first):28} | ||||||
Dog description: |
{Description of Dog:31} | ||||||
How long owned? |
{Length of time owned:34} | ||||||
| Where is this dog now? | {Where is this dog now? (Explain if you no longer have the dog):38} | ||||||
| Questions Regarding Motivation for Adopting and Intentions | |||||||
|
Who is this dog for? |
For the two of us–a couple in our mid-30s for companionship. | ||||||
Why do you want a Pembroke? |
We know that corgis are an intelligent and energetic breed, that are also adorable. Their smaller size is an important consideration for us as well, We have read that they are very empathetic and loyal, though we have not been that close to one to learn that directly. They can be demanding for attention and affection, which is perfect for us. | ||||||
Activities planned with Pembroke: |
We live in an area that is extremely dog-friendly. So going for walks, dog parks, regular parks, short hikes, and even pet-friendly shops will be a daily routine. Playing fetch or with other toys in and outside the house will be consistent. | ||||||
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 |
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|
Do you have a veterinarian? |
Yes | ||||||
Vet contact info: |
{If yes, please provide contact information including the vet’s name, clinic name, street address, city, state, zip, and phone. Also include the website if there is one.:52} | ||||||
Will handle mistakes Pembroke makes like this: |
Verbal rebuke and carry the dog to where they are supposed to go. | ||||||
Discipline: |
Verbal rebuke, corrective behavior, and immediately rewarding good behavior usually leads to positive results. Consistent application of discipline and rewards is important to avoid confusion. | ||||||
Where would Pembroke spend the majority of the time: |
During work hours, in the house. After work, they would freely roam the house or yard, weather permitting. | ||||||
Discipline: |
Verbal rebuke, corrective behavior, and immediately rewarding good behavior usually leads to positive results. Consistent application of discipline and rewards is important to avoid confusion. Where would Pembroke spend the majority of the time: During work hours, in the house. After work, they would freely roam the house or yard, weather permitting. |
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|
House dog or outside dog? |
House dog | ||||||
People at home during the day? |
No, we both work. The corgi would be home alone for up to 8 hours per day. I work close by, so if they need medication or other attention, I can come home during lunch for a few minutes. | ||||||
Where would dog eat? |
Food would probably get served in the kitchen. | ||||||
Where would dog sleep: |
Either in a pet bed or in a crate, depending on behavior. | ||||||
Play & exercise: |
We do not have kids or other dogs, so opportunities and time are wide open for several hours starting in the mid-afternoon. | ||||||
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? |
A wooden privacy fence fully enclosing the yard, primarily 6 feet high, but as low as 3 feet in a small section. | ||||||
Living arrangements: |
Own home | ||||||
Landlord info: |
{If you rent/lease your home, please list the name, telephone number and email address of your landlord. State “Not Applicable” if you own your own home.:67} | ||||||
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 | ||||||
|
Description of yard: |
The yard is fully enclosed with a privacy fence. The only fixtures are a large deck, a large portion of the garage, and the central air conditioning unit. | ||||||
Household members: |
{Describe all the people who live in your home, include names, ages and interests. For example, Mary Smith, 29, Enjoys cooking, dog training, gardening and running.:75} | ||||||
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? |
Brion Cantrell, Zelle Nelson | ||||||
Willing to train children? |
Not applicable. We will not have kids. | ||||||
|
Any allergies? |
No one is allergic. | ||||||
Current pets: |
{Please list and describe all of the pets that currently live in your home, including the name, type, age, sex and whether it is neutered. For example, Lenny, komodo dragon, 3 years old, not neutered.:80} | ||||||
|
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 that would be a goal.
Also, the previous question does not have the option that is accurate for our situation. Our cat has never lived with a dog, so we don't really know if he will be friendly. Knowing his personality, he would be run away from the dog for awhile and slowly grow to accept them. |
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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. | ||||||
|
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: |
{Personal References. Please list two people who know your family well, but who are not related to you (No moms, grandmas, sisters, etc) who will attest to the fact that you are a responsible, dedicated pet owner. Include the name of the person, their phone number(s), email and relationship you have with that person. For example, Mary Smith, 123-343-4444, 123-333-5767, marys@gmail.com, friend.:87} | ||||||