Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 01/18/2020 | 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, 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, Playful, Energetic |
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? |
I've been this breed's biggest fan for a long time, both for their goofy sweetness that constantly makes my laugh and for that slightly stubborn, independent toughness that also makes them such great working dogs. This dog would join myself and my partner (a field medic and another lifelong dog owner) in our new family-friendly and dog-filled neighborhood near the hospital I work at, and we work opposite schedules so can ensure that one of us will be home with our new family member nearly all the time. | ||||||
Why do you want a Pembroke? |
I've been this breed's biggest fan for a long time, both for their goofy sweetness that constantly makes my laugh and for that slightly stubborn, independent toughness that also makes them such great working dogs…plus that Corgi butt, of course. My family had a Corgi mix as a kid who was just the right combination of cuddly and independent, and several good friends currently own Corgis so we'd be setting up some playdates, too! | ||||||
Activities planned with Pembroke: |
Our neighborhood and social circle is extremely dog friendly, so plenty of walking and exploring nearby parks. I'd also love to get involved with some therapy dog work in the hospital, but that would be very dependent on the dog's prior socialization and comfort level with noise, smells, and new people. | ||||||
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 used to train horses for competitions (and occasionally still help my mom with her agility dogs) so I know full well that mistakes happen! I just ensure that the dog understands its a mistake, which usually means a firm, disappointed tone of voice if pointing to an accident or simply withholding the treat if working on obedience, but then it's forgotten in a matter of minutes and you move on to the next thing. | ||||||
Discipline: |
More or less the same as above, plus a lot of positive reinforcement! I try to make it really worth their while to do the right thing, whether with treats, attention, or play, and then there's less of a need for that stern voice. | ||||||
Where would Pembroke spend the majority of the time: |
In our 2-bedroom, single story unit or out in our neighborhood with us. We have several daycares in the area that have come highly recommended if our schedules change in the future, though at this point there would be little need for a dog walker or daycare while we work opposite hours. | ||||||
Discipline: |
More or less the same as above, plus a lot of positive reinforcement! I try to make it really worth their while to do the right thing, whether with treats, attention, or play, and then there's less of a need for that stern voice. Where would Pembroke spend the majority of the time: In our 2-bedroom, single story unit or out in our neighborhood with us. We have several daycares in the area that have come highly recommended if our schedules change in the future, though at this point there would be little need for a dog walker or daycare while we work opposite hours. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes, as above! We work opposite hours, so there will almost always be someone home day or night. | ||||||
Where would dog eat? |
Probably in our kitchen, where we have a little corner perfectly sized for a water and food bowl. | ||||||
Where would dog sleep: |
Depending on its preference, a dog bed in the hall or in our bedroom – possibly on the bed (I'd try not to set that precedent, but if they already did I wouldn't mind!). | ||||||
Play & exercise: |
At least one walk a day, probably one with each of us every day, and some toys in the house for anytime play, too. | ||||||
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: |
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? |
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Lease allow dogs: |
Yes, my lease permits dogs. | ||||||
Landlord permission: |
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Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
Small front yard, no pool or other hazards, on quiet side street in residential neighborhood with three parks (at least two dog friendly) within a few blocks from our front door. | ||||||
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? |
Shared responsibility between myself and my partner | ||||||
Willing to train children? |
No children in the home. | ||||||
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} |