Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 04/08/2020 | 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 | Gender preferred: |
Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Outgoing, Quiet |
Other preferences: |
We have two cats that have been raised with dogs and would expect to be friends with a new dog. They are NOT "dog savvy". One cat in particular would expect to PLAY with a new dog. | ||||||
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? |
Our family | ||||||
Why do you want a Pembroke? |
We've always had larger dogs. Our current dog is an elderly boxer, before that we had a French mastiff/boxer mix, and before than a lap/shepherd mix. We would like a smaller dog, but one that doesn't think it's a "small" dog. 😉 We have a good friend who had an amazing Corgi that we loved. We have done some research. The only thing that has concerned me is the possibility of the prey drive. | ||||||
Activities planned with Pembroke: |
We have a small fenced yard, so we've preferred to take our dog on shorter walks in the neighborhood. Our current dog gets anxious in the car, and does not like other dogs, but we'd love to be able to bring a dog with us, and head to the dog park. | ||||||
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: |
Positive reinforcement! | ||||||
Discipline: |
We've done mostly positive reinforcement. We'd be open to treat training as well. Our current dog is NOT food motivated, so treat training didn't work for him. | ||||||
Where would Pembroke spend the majority of the time: |
At home. In the summer we often make day trips to Duluth and state parks. | ||||||
Discipline: |
We've done mostly positive reinforcement. We'd be open to treat training as well. Our current dog is NOT food motivated, so treat training didn't work for him. Where would Pembroke spend the majority of the time: At home. In the summer we often make day trips to Duluth and state parks. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
We all have varying schedules. My husband and I work full-time. We have a high school junior who gets home every day at 3:30. Our adult son works from 2pm – 10pm, but he travels out of the country frequently. We also have three adult daughters and a 7yo grandson who are at our house frequently during the day. | ||||||
Where would dog eat? |
We feed our current dog IAMS, a senior formula with occasional high quality canned food as a treat (and to hide meds). | ||||||
Where would dog sleep: |
Our current dog sleeps in our den at night (open door). He'd sleep in our room but is a VERY LOUD sleeper (snoring, snorting, flapping lips/ears! ha!). He gets to sleep in our room if there is a storm. I assume we'd have a new dog sleep in our room (not in our bed), or in the den like our current dog. | ||||||
Play & exercise: |
Our current dog gets walked 3-4 times a day, let out in the backyard, and we have a variety of toys (and the cats). | ||||||
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? |
Typical chain link fence. I know they can be diggers, so we'd be prepared to make the fence so they couldn't get under it. | ||||||
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: |
|||||||
Landlord permission: |
|||||||
Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
Very small fenced backyard with a shed. | ||||||
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? |
Don Deutsch | ||||||
Willing to train children? |
Yes. Our 7yo grandson is at our house VERY frequently, nearly daily. He's been very good with our current dog and cats. | ||||||
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? |
Yes, to a point. I'd reach my limit quickly on a dog that was aggressive to our cats.
Please note, we DO NOT want to adopt another dog until AFTER our current dog passes which is why I didn't list him above. Gus is 13yo, diagnosed with aggressive anal gland cancer, and declining quickly. 🙁 I just know that sometimes you can be on a list for a long time before there is an available dog. |
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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} |