Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 11/18/2019 | 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: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Energetic, Very Active |
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? |
This Pembroke is for myself and my family. My husband, Kash grew up with corgis and we are ready to welcome one into our home and what better way than to adopt? | ||||||
Why do you want a Pembroke? |
As said previously, my husband grew up with corgis and I have been around his family's corgi and one of our friends has three. They make excellent companion dogs, they are energetic and loyal. A great family dog, which is exactly what we need. | ||||||
Activities planned with Pembroke: |
We would walk and overall spend a lot of time outdoors. Our Pembroke would go with us on family vacations and truly be a member of our family. | ||||||
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: |
I would address the mistake and make it known that it was not okay. I would use whatever word we use when training to establish bad behavior. | ||||||
Discipline: |
In the past we have always taken the dog outside or given the dog a toy. For instance if the dog had an accident inside, we would go outside. If the dog was chewing on the furniture then we would give a toy or go outside to play. | ||||||
Where would Pembroke spend the majority of the time: |
The Pembroke would spend the majority of her time doing whatever we are doing. So, during the summer that would be playing outside, going to the lake, enjoying everything outdoors. During the winter, we still enjoy walks, but typically spend more time indoors. | ||||||
Discipline: |
In the past we have always taken the dog outside or given the dog a toy. For instance if the dog had an accident inside, we would go outside. If the dog was chewing on the furniture then we would give a toy or go outside to play. Where would Pembroke spend the majority of the time: The Pembroke would spend the majority of her time doing whatever we are doing. So, during the summer that would be playing outside, going to the lake, enjoying everything outdoors. During the winter, we still enjoy walks, but typically spend more time indoors. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes. My husband works from home. | ||||||
Where would dog eat? |
I would keep my corgi on the same diet that the foster home had them on unless our vet advised otherwise. | ||||||
Where would dog sleep: |
The corgi would most likely sleep on a dog bed in our master bedroom, or on the bed, whichever the corgi was used to. | ||||||
Play & exercise: |
We have a large yard that would be a prime location for fetch and general play. We also go on walks once a day, but obviously with a dog we would increase that. There is also a nearby dog park that we would enjoy. We would offer our dog as much play and exercise as needed. At least four hours a day. | ||||||
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: |
We have a large 2 1/2 lot yard. There is a small home, detached garage, small swing set, and five trees. | ||||||
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? |
Victoria | ||||||
Willing to train children? |
Yes. Our children have been around other family members animals since day one and have always been taught how to handle and treat animals. | ||||||
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? |
There are currently no other pets in the home. | ||||||
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} |