Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 11/09/2019 | 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: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Outgoing, Playful, Energetic, Other (Please describe in the box below.) |
Other preferences: |
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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? |
Myself Glenn Lambert | ||||||
Why do you want a Pembroke? |
Corgis are my favorite breed. I have owned 2 of them many years ago. They are a small dog with a large dog personality. They are intelligent, loyal, trainable. They are not difficult to groom. I owned 2 in my younger 20s and was very happy with them. I had a red and a tri-black headed. | ||||||
Activities planned with Pembroke: |
This will be a pet but I want to obedience train he dog and possibly train it to be a therapy dog. They have a sweet personality for 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: |
Remove the dog from the situation. Put him/her in a time out situation or cage if needed. It would depend on the severity. If it is a behavior that can be corrected, I will show the dog the proper thing to do. Piddles on the floor, I say NO! and take the dog outside to finish and then praise the dog if it goes outside. | ||||||
Discipline: |
I use a one word vocabulary for commands and a tone of voice that let's the dog know I am disciplining them. I don't yell or hit the dog. I usually take the dog by the head firmly and reinforce the one word command I use for the situation like, No!, Bad! Bed! etc | ||||||
Where would Pembroke spend the majority of the time: |
In the house on the main floor. I work from home so it may spend some time with me in my home office. | ||||||
Discipline: |
I use a one word vocabulary for commands and a tone of voice that let's the dog know I am disciplining them. I don't yell or hit the dog. I usually take the dog by the head firmly and reinforce the one word command I use for the situation like, No!, Bad! Bed! etc Where would Pembroke spend the majority of the time: In the house on the main floor. I work from home so it may spend some time with me in my home office. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes. I work from home | ||||||
Where would dog eat? |
In the kitchen | ||||||
Where would dog sleep: |
Bed in the kitchen over night. Possible crate training depending on its personality. | ||||||
Play & exercise: |
I have a fenced in yard so I can let it out off the leash after it does "its business. I also like to take walks and go in public for socialization. My daughter has Australian Cattle Dogs that my talk will socialize with as well. | ||||||
How will you exercise your dog? |
Both on leash and restrained to the yard | ||||||
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? |
Wood picket fence with small spaces between the slats | ||||||
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: |
Fenced in backyard with a shed and gates that are fastened shut when not in use. | ||||||
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? |
Myself Glenn Lambert | ||||||
Willing to train children? |
There are no children at home. My daughter is a dog daycare operations manager and her son (my grandson) is extremely well behaved and loving to dogs. He has been around them his whole life. He's 11 | ||||||
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? |
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Are you willing to work on it if your new dog doesn’t get along with your current pets right away? |
N/A | ||||||
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} |