| Date & Referral Source | |||||||
| State: | {Applicant State:2} | Date of Application: | 02/18/2019 | 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: |
Red & White, Red Headed Tri, Black Headed Tri, Sable & White, Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful |
Other preferences: |
I have an 8 year old Corgi female who is fairly vocal, so I know that they can be. She also loves herding the 3 cats when on the first floor. I prefer a friend for her that doesn't play roughly, because she had a spinal Injury 3 years ago, is fully functioning and well healed and receives regular chiropractic care. Too rough could reinjure her or the other Corgi. | ||||||
| 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? |
Myself | ||||||
Why do you want a Pembroke? |
I have a Corgi. She's a sweetheart, funny, very smart, at times stubborn, she loves everyone, including her vet, vet techs, and total strangers. She thinks everyone loves her too and can't understand why everyone doesn't love her back. She loves any food and any treat, not picky. She'll fall over in a heartbeat for a belly rub from anyone and anywhere if they pet her. She's a complete character and I have fallen in love with the breed. I have always had dogs from when I was 14 until present at 69. Before 61, I had all big dogs- mostly labs and Rotties. But when I became older I thought a smaller breed would be better for me. Since I am of mostly Celtic origin, I took a look at their breeds and I wasn't looking for a lap dog. Other than the massive amounts of hair that this 22 lb. Girl makes, I just fell in love with the Corgi. She, well actually all of them, make me laugh and smile all the time. | ||||||
Activities planned with Pembroke: |
Training, going for short, but a few walks, in the summer playing in a wading pool, and winter in the snow, and tossing a ball. We also play tug until mine decides it's time to play keep-away! | ||||||
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: |
I always use just my voice. For example, if the dog chews on something it shouldn't, I say " no " in a stern voice and then hand it an appropriate chew. It requires time, patience, observation, persistence, and consistency; it's just like raising children. | ||||||
Discipline: |
I use a combination of positive reinforcement with treats and negative reinforcement with my disapproving tone. I realize that in the beginning of being together, the dog and I need to learn about each other, learn to trust each. So you need to understand that the dog might be regressing out of fear, confusion about what the heck is going on in its life, and be soft, kind, reassuring and safe. | ||||||
Where would Pembroke spend the majority of the time: |
In the house with me and Moxie, or outside in the yard or barn with me. | ||||||
Discipline: |
I use a combination of positive reinforcement with treats and negative reinforcement with my disapproving tone. I realize that in the beginning of being together, the dog and I need to learn about each other, learn to trust each. So you need to understand that the dog might be regressing out of fear, confusion about what the heck is going on in its life, and be soft, kind, reassuring and safe. Where would Pembroke spend the majority of the time: In the house with me and Moxie, or outside in the yard or barn with me. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes, me | ||||||
Where would dog eat? |
In the kitchen separated from the other. | ||||||
Where would dog sleep: |
On the 1st floor in a crate near where Moxie sleeps in her crate ( which began 3 years ago when she hurt her back). Since then she hasn't been allowed to go up and down the stairs by me, and I can no longer carry her up and down. Sleeping near Moxie, I feel they can bond better in a " type of pack". | ||||||
Play & exercise: |
I live on a horse farm and when I feel comfortable that the Corgi will listen to me and not run off or get lost, there will be plenty of room for the Corgi to run and play. | ||||||
How will you exercise your dog? |
On leash | ||||||
|
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 horse farm | ||||||
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: |
There's an enclosed chicken coop and run, a garden and a few raised vegetables beds, and the horse pastures and barn | ||||||
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? |
Jeanne Krug- I live alone | ||||||
Willing to train children? |
I will make sure that children will treat my animals correctly. My children are grown and I have no grandchildren. | ||||||
|
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 | ||||||
|
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: |
{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} | ||||||