Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 05/03/2020 | 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 | Gender preferred: |
Male | Color preferred: |
Red & White, Red Headed Tri, Sable & White | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Energetic |
Other preferences: |
We have many friends with children — and hope, in the next several years, to have children ourselves — so we would like the dog to be good around children.
My parents also have a dog, so we would like the dog to get along reasonably well with other dogs. We will be moving into our home late July, so we hope to adopt the dog some time after that point. |
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Dog Ownership History | |||||||
Previous dog owner? |
No | ||||||
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 us (Christine and James). We are moving into a house at the end of July and would love to welcome a dog into the family after that point. The house is two blocks away from a forest preserve and cannot wait to take our dog on a walk every day! | ||||||
Why do you want a Pembroke? |
We have done research on the breed. We are drawn to Pembroke Welsh Corgis because they are good family animals and are herding animals. We want a dog that wants to be with us. We view our future dog as a valued member of the family and want the dog to be integrated into our lives (being around the house, taking walks each day outside, etc). We also really love the look of the Pembroke Welsh Corgi. 🙂 We think that they are very cute! | ||||||
Activities planned with Pembroke: |
Our new house is two blocks away from a forest preserve. We want to take our dog to the preserve on a regular basis. We also want to take him on daily walks around the neighborhood.
We also want to play with our Pembroke in the home. We look forward to buying toys for him and playing whatever games he finds amusing. We would also be happy if he would be willing to sit on the couch with us while we watch tv. |
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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: |
Telling the dog no.
We will be new dog owners and are happy to take him to dog obedience school so that we can all learn together. 🙂 |
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Discipline: |
Telling the dog no and using rewards to reward good behavior.
We will be new dog owners and are happy to take him to dog obedience school so that we can all learn together. 🙂 |
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Where would Pembroke spend the majority of the time: |
Inside our home. | ||||||
Discipline: |
Telling the dog no and using rewards to reward good behavior.
We will be new dog owners and are happy to take him to dog obedience school so that we can all learn together. 🙂 |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes, my husband James is home during the day. | ||||||
Where would dog eat? |
The kitchen. | ||||||
Where would dog sleep: |
In a dog bed inside our home. | ||||||
Play & exercise: |
We take a 40 minute walk every day, weather permitting, and want to take the dog with us. Given our proximity to a forest preserve, we will take longer walks to the preserve on weekends. | ||||||
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: |
We will be moving into our own home in late July. | ||||||
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: |
No swimming pools. There is a deck in the back yard, a raised garden patch, and a shed (the corgi will not live in or frequent the 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? |
James and Christine | ||||||
Willing to train children? |
We do not currently have children, but we will take that time when they come along. | ||||||
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? |
Yes. | ||||||
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} |