Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 08/21/2019 | 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, 5 years – 10 years | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Outgoing, Quiet |
Other preferences: |
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Dog Ownership History | |||||||
Previous dog owner? |
No | ||||||
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? |
Me and my children, autistic daughter is 5 and son is 2 | ||||||
Why do you want a Pembroke? |
My cousin had a corgi and I absolutely loved him when we visited my cousins.. They’re friendly, easygoing, snuggly dogs. I also love the way they look- I identify strongly with having short legs and a stout body! | ||||||
Activities planned with Pembroke: |
Go on walks, play, I am hoping to train my animal to be a therapy dog (but if the dog won’t accept the training I’m fine with it) | ||||||
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: |
Pavlovian reinforcement- if the dog does a behavior I like, reward the dog. If the dog does something naughty and then stops, he or she will get a reward and make a correlation between behaving and treats. | ||||||
Discipline: |
At most, a firm no. In no scenario would I spray bottle spritz or hit – after all I wouldn’t spritz my kids, so it makes no sense! I prefer to redirect the behavior as much as possible. | ||||||
Where would Pembroke spend the majority of the time: |
Inside the house with me. | ||||||
Discipline: |
At most, a firm no. In no scenario would I spray bottle spritz or hit – after all I wouldn’t spritz my kids, so it makes no sense! I prefer to redirect the behavior as much as possible. Where would Pembroke spend the majority of the time: Inside the house with me. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes almost always. | ||||||
Where would dog eat? |
We’d first try what you’d recommend and what he/she has already been eating, but if there are veterinary needs I am prepared to spend $$$ on whatever food is recommended by her vet | ||||||
Where would dog sleep: |
In his/her own bed in the floor in my room or my kids’ room | ||||||
Play & exercise: |
Since I stay home most of the day I think I’ll have a lot of opportunities, but I mostly plan to walk the dog in the morning, and when picking up the kids from school, and at night. | ||||||
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 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: |
We have a big yard for running, and a small swing set. No pool or anything. | ||||||
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? |
No, some members of the family do not want 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? |
Renee Dragani (myself) and my two children | ||||||
Willing to train children? |
Very willing. Like I said, we want to train the animal to be a therapy dog, so we have to train the dog to observe those behaviors and train the kids how to treat a dog | ||||||
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? |
Not applicable | ||||||
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} |