Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 11/15/2019 | Referred by: | Other | ||
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 | Gender preferred: |
Female | Color preferred: |
Any color | Activity level: |
Outgoing, Quiet, Playful |
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 | ||||||
Why do you want a Pembroke? |
I have been fortunate to live with two wonderful Pembroke Welsh Corgis. What do I love about them? I love their intelligence, their stubborn personality, their energy, their independence, their ability to love totally when they respect their people. Both of my Corgis let me believe I was the "Alpha" when they both knew they were really in charge, but I knew they totally loved me and worked to protect me and make sure I was happy. There's many other things I love about Corgis – I love their smile, their sense of humor, their "can do" attitude and strength, their ability to "read" a person or another animal and be gentle and loving when needed. | ||||||
Activities planned with Pembroke: |
I will take my new Pembroke for walks, trips to the dog parks, trips to local dog friendly stores and snuggle and cuddle when they are willing. I will initially have the two of us take an obedience class so I can learn the best things to do so we can work as a team. Other activities would depend on what the dog likes to do. | ||||||
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: |
Currently my 15 year old Pembroke, Queen Bodecea, has several potty accidents daily. She likes to supervise me while I'm cleaning up her accident and pee pads. I put my arm around her and tell her how much I love her. I'm not real sure what you mean by mistakes but I have a habit of either using the mistake as a trainable moment or to just clean it up and move on. | ||||||
Discipline: |
I'm a huge proponent of positive reinforcement when training or disciplining a dog. I have taken courses plus have participated in several obedience courses with both of my dogs using positive reinforcement. | ||||||
Where would Pembroke spend the majority of the time: |
With me inside my home. | ||||||
Discipline: |
I'm a huge proponent of positive reinforcement when training or disciplining a dog. I have taken courses plus have participated in several obedience courses with both of my dogs using positive reinforcement. Where would Pembroke spend the majority of the time: With me inside my home. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Most of the day. I work part-time some days but the majority of the time I am home with the dogs. | ||||||
Where would dog eat? |
In the house. Currently each dog has their own designated place to eat. | ||||||
Where would dog sleep: |
I would like the dog to sleep in the bedroom with me but my experience with Corgis tells me that they sleep where they want to sleep. | ||||||
Play & exercise: |
Daily walks, multiple weekly trips to the local dog park if they like it, puzzle toys and games of fetch in the house when the weather is bad. | ||||||
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: |
I have a large, unfenced yard on the end of a cul de sac. No swimming pools or other dangers. There are many dogs living on this dead end block. | ||||||
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 | ||||||
Willing to train children? |
My children and my grandchildren are adults. All have lived with dogs their entire lives. | ||||||
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? |
Of course. A dog is not a fashion accessory that goes out of style and is discarded. A dog is a life long relationship. This is why I don't want to adopt a puppy or very young Corgi. | ||||||
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} |