Untitled_2401

Applicant IL
State: {Applicant State:2} Date of Application: 05/30/2019 Referred by: Website
First name: {First Name:98} Last name: {Last Name:97} First name 2: {First Name 2:94} Last name 2: {Last Name 2:93}
Street: {Street Address:3}
City: {City:4} State: {State:5} Zip: {Zip:6}

Ages interested in:
 0 months – 1 year (we rarely get dogs in this age group), 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, Very Active, Other (Please describe in the box below.)

Other preferences:

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}

Who is this dog for?

 My name is Alyssa Summers and I am looking for a dog to become my ESA. I would love to pick out a rescue dog instead of “shopping” for a dog.

Why do you want a Pembroke?
 I am seeking an ESA and want to pick a rescue dog. I have done research on corgis and believe that it is the perfect size dog for my residence and has the characteristics I desire.

Activities planned with Pembroke:
 Go on walks around the block, visit local dog parks, and lounge at home.

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

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: 		Depending the mistake I would respond differently. For example, if the dog poops in the house, I would then say “no”, pick up the poop, and take the poop and the dog outside. Therefore, the dog can learn “no” and learn how to fix the mistake by seeing the poop outside.

Discipline:
 Verbal and teaching. If the dog doesn’t learn how to fix a mistake, he or she will continue.

Where would Pembroke spend the majority of the time:
 At the dog park, at home, or by my parents place, visiting my sister’s dog.

Discipline:
 Verbal and teaching. If the dog doesn’t learn how to fix a mistake, he or she will continue.
Where would Pembroke spend the majority of the time: At the dog park, at home, or by my parents place, visiting my sister’s dog.

House dog or outside dog?

 House dog

People at home during the day?
 Yes

Where would dog eat?
 Inside, out of a food bowl in his or her bedroom

Where would dog sleep:
 Either in my bed or a bed in his or her bedroom

Play & exercise:
 Walks around the block and/or going to the dog park. He/she will be able to exercise and play everyday for about 2-3 hours, usually between 2pm and 5pm.

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?

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?
 No, you may not contact my landlord.

Lease allow dogs:
 No, my lease does not permit dogs.

Landlord permission:
 Yes, my landlord is fine with me owning a Pembroke

Restrictive covenants?
 Not applicable

Breed/size restrictions?
 No

Description of yard:

 Some grass

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?

 No, I will not 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?
 Alyssa Summers

Willing to train children?
 I don’t have children at the moment but if I was to ever have children, I would be willing to take the time to teach my 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?

Are you willing to work on it if your new dog doesn’t get along with your current pets right away?
 I don’t own any other pets

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}