Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 05/06/2020 | 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: |
1 year – 3 years, 3 years – 5 years, 5 years – 10 years, 10 years +, Any age | Gender preferred: |
Male, Female, Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Outgoing, Playful, Other (Please describe in the box below.) |
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? |
me | ||||||
Why do you want a Pembroke? |
I have owned PWC's off and on since I was thirteen. Showed two Pems to their AKC Championship back then. In the 90's living in Holland I had a Pem (not show quality) and a Cardigan who won various championships. In the meantime I've also owned a Japanese Akita and a Pem when I lived i San Francisco. I love the breed for its intelligence, loyalty and will to please. The alert expression inspires me. |
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Activities planned with Pembroke: |
Walking, hiking possibly agility, but that's more of a long shot. I would love to get back into conformation but that will have to wait until retirement and a dog that fits that bill better. |
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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: |
If quick enough, a sharp 'NO' would resound. If practicable, I would lead the Pem through the correct behavior and praise him |
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Discipline: |
Voice only. With puppies I've had good luck with a spray bottle .. . |
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Where would Pembroke spend the majority of the time: |
I work from home a lot, so he/she would be with me at home or on walks. When I travel by air, I would have to see if the dog is welcome where I'm going, fits under the seat, etc. Otherwise a first priority would be finding people to stay with when I'm gone |
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Discipline: |
Voice only. With puppies I've had good luck with a spray bottle .. . Where would Pembroke spend the majority of the time: I work from home a lot, so he/she would be with me at home or on walks. When I travel by air, I would have to see if the dog is welcome where I'm going, fits under the seat, etc. Otherwise a first priority would be finding people to stay with when I'm gone |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
I am often home several hours a day | ||||||
Where would dog eat? |
I need to research dog foods again. My last Corgi was on a weight loss program. She was a rescue and her previous owner had fed her a bit too well, so I had special food from the vet. | ||||||
Where would dog sleep: |
On a nice pillow next to my bed or in a crate if that would be better for the dog | ||||||
Play & exercise: |
Big park across the street with lots of other possibilities to play with other dogs. All Corgis I've ever had loved to chase a ball, go swimming, learn new games |
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How will you exercise your dog? |
On leash | ||||||
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? |
Wooden, six feet high. The gate needs to be fixed | ||||||
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: |
The yard is mostly paved and has raised flower beds. I would not use the back yard for the dog at all, since I have a park across the street | ||||||
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? |
Craig Wiggins | ||||||
Willing to train children? |
I have no children in my household, but I will diligently work with children I encounter to help them learn how to approach a dog. | ||||||
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} |