| 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: |
0 months – 1 year (we rarely get dogs in this age group), 1 year – 3 years | Gender preferred: |
Male | Color preferred: |
Any color | Activity level: |
Outgoing, Playful, Other (Please describe in the box below.) |
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 myself and my other dog, Latte (2 years old, spayed, UTD on vaccines). | ||||||
Why do you want a Pembroke? |
Originally, I wanted to adopt a corgi for their cute little butt; however, once I met an actual corgi (one of my coworkers owns one) I immediately fell in love with how loyal he is and energetic. I realized a corgi might be a well rounded companion for my other dog, Latte. My coworker's corgi seemed to get along with her which gave me the impression that corgis might be potential good companions. | ||||||
Activities planned with Pembroke: |
I tend to take Latte out for walks three times a day for 20min. This is the time I use for her to potty and get some fresh air (unless it is snowing that it is 10min walks four times a day). On weekends, when I stay in WI, we go to the dog park or when I visit family in Illinois, we take walks around the neighborhood. | ||||||
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 believe in positive reinforcement and treats. For example, when Latte has had an accident in the house, especially if I caught in her in the act, I would immediately take her outside. If she goes potty outside, I will give her a treat, if she doesn't, just for being outside, I would tell her that she is a good girl. | ||||||
Discipline: |
I believe in patience and treats for good behavior. | ||||||
Where would Pembroke spend the majority of the time: |
In my apartment and surrounding neighborhood in Wisconsin since I moved up here for work. | ||||||
Discipline: |
I believe in patience and treats for good behavior. Where would Pembroke spend the majority of the time: In my apartment and surrounding neighborhood in Wisconsin since I moved up here for work. |
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|
House dog or outside dog? |
House dog | ||||||
People at home during the day? |
No, however, I am gone only for work (about 8 hours) and he will have Latte as a companion while I am away. | ||||||
Where would dog eat? |
He will have his own dishes for food and water. Most likely buy him dry royal canine food (Latte eats the mini series, for him, most likely the medium series) unless my vet recommends another brand. | ||||||
Where would dog sleep: |
He will have his own bed in my bedroom just like my other dog. | ||||||
Play & exercise: |
Everyday he will be taken out for walks 3 times a day for 20min (once early morning around 7am, again before I leave for work (around 1:30pm) and then once after I get out of work (10pm). On the weekends I tend to take my dogs out to the dog park for an hour or so unless it is snowing or raining. | ||||||
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: |
Rent/lease 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? |
Yes, you may contact my landlord. | ||||||
Lease allow dogs: |
Yes, my lease permits dogs. | ||||||
Landlord permission: |
Yes, my landlord is fine with me owning a Pembroke | ||||||
Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
Yes | ||||||
|
Description of yard: |
N/A | ||||||
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? |
Jasmine Soto | ||||||
Willing to train children? |
N/A but if I encounter a child, I usually teach them how to handle them. | ||||||
|
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, it takes time and patience for dogs to get accustomed to one another | ||||||
|
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} | ||||||