Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 05/24/2020 | 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 | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful |
Other preferences: |
Preferably no medical conditions. | ||||||
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? |
Both of us | ||||||
Why do you want a Pembroke? |
They are so cute, kind, and loving. I know some people with corgis and they seem to be great companions. I have done research about them, I have found that they're active, require lots of stimulation to use up their energy. They're a herding breed. I have a lot of time, no children, so I believe I could give a lot of attention to the corgi. I have read that they are very affectionate. I'm looking for a small to medium sized dog, I don't want a large dog and I don't have the room for one either. I have read that they tend to overeat/be overweight, so I am prepared to monitor their nutrition. | ||||||
Activities planned with Pembroke: |
I can take the corgi on a walk in the morning and a longer walk when i get home from work. I can possibly take the corgi out on a walk during my lunch break. I would bring it to the open field and play fetch/frisbee with the corgi. I enjoy long walks, so that is mainly the activity I will do with the corgi. My fiance absolutely loves dogs, and he is prepared to give the corgi lots of attention and affection, as am I. | ||||||
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: |
I would give the corgi a scolding, I wouldn't hit the corgi. I would bring the corgi to the mistake, and point to the mistake and scold the corgi so it will associate the scolding to the mistake/object. I would never scream at the corgi or hit it. I would not even hit it on the nose with a rolled up newspaper. | ||||||
Discipline: |
Positive reinforcement, negative reinforcement, vocal scolding but not yelling. Never hitting. Distraction. | ||||||
Where would Pembroke spend the majority of the time: |
At our home (inside). We have a ranch style home in a rural town of Manning, IA. | ||||||
Discipline: |
Positive reinforcement, negative reinforcement, vocal scolding but not yelling. Never hitting. Distraction. Where would Pembroke spend the majority of the time: At our home (inside). We have a ranch style home in a rural town of Manning, IA. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Usually no. But I work as a nurse, so I only work 3 days a week. so 4 days of the week I will be at home all day | ||||||
Where would dog eat? |
Nature's variety dog food, core wellness dog food. Corgis should avoid, soy, and wheat. Corgi should have a balanced diet of protein and fat such as chicken, beef, fish, lamb, and omega 3 fatty acids. |
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Where would dog sleep: |
The corgi can sleep in the living room on the dog bed or in our bedroom on their dog bed or even in our bed too. | ||||||
Play & exercise: |
Yes the corgi will have opportunity for play and exercise. We will take the corgi on long walks, and take the corgi to the open field to play and run with the corgi. We will play with balls, tugging toys, and frisbees. | ||||||
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: |
Renting currently, but our house is currently being built. | ||||||
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: |
|||||||
Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
No swimming pools, just small yard, but not fenced in. There is a front yard too. We have neighbors nearby that do not have swimming pools. | ||||||
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? |
Kristian Tran | ||||||
Willing to train children? |
Yes. But I don't have any kids. But yes I will teach my future kids. | ||||||
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? |
I don't have any current pets. | ||||||
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} |