| Date & Referral Source | |||||||
| State: | {Applicant State:2} | Date of Application: | 02/21/2019 | 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, 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? |
Wife and teenage kids. | ||||||
Why do you want a Pembroke? |
We have a fenced-in backyard and a doggie door, the perfect size for a small to medium sized dog. Our beagles love it. I've done research but haven't had much exposure to the breed. I like the fact that they are protective of the family. My wife feels safer with a dog around. She doesn't want a guard dog. | ||||||
Activities planned with Pembroke: |
Our family is active. We have many activities outside of our house to incorporate the dogs. | ||||||
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? |
No | ||||||
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 would be consistent and firm when the dog is in training or not obeying the rules of the house. This breed need to know that the human is the master and not the other way around. | ||||||
Discipline: |
Push the dog over (quickly but gently) either on to his side or onto his back and lean over him. This reinforces that you are dominant. We've used spray bottles and short time-outs. | ||||||
Where would Pembroke spend the majority of the time: |
Like I said, we have a doggie door that leads to the backyard and we have a dog perch (Throne) that sits level with an outside window. Our Beagles would sit and watch the birds and wait for us to come home from there. | ||||||
Discipline: |
Push the dog over (quickly but gently) either on to his side or onto his back and lean over him. This reinforces that you are dominant. We've used spray bottles and short time-outs. Where would Pembroke spend the majority of the time: Like I said, we have a doggie door that leads to the backyard and we have a dog perch (Throne) that sits level with an outside window. Our Beagles would sit and watch the birds and wait for us to come home from there. |
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|
House dog or outside dog? |
House dog | ||||||
People at home during the day? |
With 3 boys ages Jr. High through College we have people coming and going at all hours of the day. | ||||||
Where would dog eat? |
We have a separate dog eating area where water and food are given. Away from the kitchen. | ||||||
Where would dog sleep: |
We have the "Throne", another dog bed adjacent to that and another dog bed in an upstairs bedroom. | ||||||
Play & exercise: |
At least twice day. I workout/walk in the mornings and my wife does so in the evenings. | ||||||
How will you exercise your dog? |
On leash | ||||||
|
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? |
It's a 4 ft high picket fence with brick pavers under the bottom of the slates so the dogs cannot dig under the fence. | ||||||
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 doggie door exits out onto a back deck. The deck is 2 1/2 feet off the ground. Walk down the steps and the yard is 60 ft deep and 90 ft wide. There is a shed and shrubbery. | ||||||
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? |
Keith | ||||||
Willing to train children? |
Yes | ||||||
|
Any allergies? |
One or more family members might be allergic to dogs. | ||||||
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. Daisy is not an alpha. | ||||||
|
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} | ||||||