| Date & Referral Source | |||||||
| State: | {Applicant State:2} | Date of Application: | 05/23/2019 | 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: |
Any age | Gender preferred: |
Male, Either a Male or a Female | Color preferred: |
Red & White | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Other (Please describe in the box below.) |
Other preferences: |
Our #1 want is a fluffy corgi. Also, aware they are not easy to come by but that will always be at the top of our list. | ||||||
| Dog Ownership History | |||||||
Previous dog owner? |
Yes | ||||||
Dog 1 |
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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? |
Us | ||||||
Why do you want a Pembroke? |
We have owned 3 corgis in the past 11 years. We love their personality, the frapping and splooting and their lovableness. | ||||||
Activities planned with Pembroke: |
We like to attend a lot of dog friends events and businesses. Patios are restaurants and breweries, rescue sponsored events (dog day at baseball games, hockey, etc.). Otherwise we go to local parks for walks or cuddle and play fetch at home. |
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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: |
Depends on the mistake. We like to train them to "leave it" if there were something they should not eat. Move them away from the situation or the issue causing the situation if applicable. A firm no if needed. | ||||||
Discipline: |
We try to reward them for all of their positive behavior. Just a firm no mostly for discipline if needed. Get them to do something they know how to do instead to change things positive. | ||||||
Where would Pembroke spend the majority of the time: |
During work hours, a 10 x 6 foot mud room (enclosed with a gate) with their beds and water. When we are home, wherever they feel like lounging. We have steps for the couches and our beds, they are allowed on both. |
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Discipline: |
We try to reward them for all of their positive behavior. Just a firm no mostly for discipline if needed. Get them to do something they know how to do instead to change things positive. Where would Pembroke spend the majority of the time: During work hours, a 10 x 6 foot mud room (enclosed with a gate) with their beds and water. When we are home, wherever they feel like lounging. We have steps for the couches and our beds, they are allowed on both. |
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|
House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Weekends yes, We work Monday through Friday normal business hours. | ||||||
Where would dog eat? |
Bowls are set up next to the kitchen. | ||||||
Where would dog sleep: |
In our room (we do close the door so they can't roam). Wherever they like, on our bed, in their bed, under the bed. | ||||||
Play & exercise: |
We have a large acreage so they get plenty of room to frap and play. When it's rainy or cold we play fetch or hide and seek inside or we have puzzle treat games. Otherwise it's walks at several local parks. We do not have our acreage fenced in however they are never allowed outside without our supervision. They are trained on leash first their boundaries and to come when called and even then they still never go outside with out us. |
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How will you exercise your dog? |
Both on leash and restrained to the yard | ||||||
|
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: |
{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: |
No pool. 6 acres in the country, all neighbors have large acre lots as well though we train them to know our boundaries. But again, they are never outside alone without us watching. Large enclosed deck that has been their favorite spot to overlook the countryside. |
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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? |
Combined Drew and myself | ||||||
Willing to train children? |
Yes, but no children or plans for children at this time. | ||||||
|
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} | ||||||