Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 07/18/2020 | 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 | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful |
Other preferences: |
|||||||
Dog Ownership History | |||||||
Previous dog owner? |
Yes | ||||||
Dog 1 |
|||||||
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? |
They would be a family pet for both of us. | ||||||
Why do you want a Pembroke? |
We would like a companion for our current pup but also would like to complete our family. We love our current pup Waffles. We love her expressions, how friendly she is, how quickly she learns new things, how good she is around people and other dogs. We did research on the breed before we got Waffles. | ||||||
Activities planned with Pembroke: |
We take Waffles anywhere we can. During COVID times that is a little more limited but we take her on trips, to the store, to visit friends, long walk, to work occasionally. She loves to travel and be with us doing whatever we are doing. Daily we take her on 2-3 walks a day. We play fetch with her. We have several different "thinking" toys we've given her over the time we've had her to make her use her mind to get treats. | ||||||
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 |
||||||
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: |
We've trained Waffles our current pup to know what is right/wrong with high-value treats. When they do something well we reward and when they do something wrong we do not. We've had great success with this method with Waffles. | ||||||
Discipline: |
We've trained Waffles our current pup to know what is right/wrong with high-value treats. When they do something well we reward and when they do something wrong we do not. We've had great success with this method with Waffles. | ||||||
Where would Pembroke spend the majority of the time: |
Inside our home. Our current pup is an inside dog. With COVID Tim continues to work from home, so Waffles has full reign of the entire house. When we need to leave she is able to roam in the first level of the house, which includes the living room, dining room, and kitchen. Our stairs are gated off to limit access to the second level when we are out. | ||||||
Discipline: |
We've trained Waffles our current pup to know what is right/wrong with high-value treats. When they do something well we reward and when they do something wrong we do not. We've had great success with this method with Waffles. Where would Pembroke spend the majority of the time: Inside our home. Our current pup is an inside dog. With COVID Tim continues to work from home, so Waffles has full reign of the entire house. When we need to leave she is able to roam in the first level of the house, which includes the living room, dining room, and kitchen. Our stairs are gated off to limit access to the second level when we are out. |
||||||
House dog or outside dog? |
House dog | ||||||
People at home during the day? |
With COVID Tim continues to work from home, but likely at some point in the future, he will return to work. Waffles is both crates trained and house trained. We would work to do the same for our new pup so that if / when needed we can leave them at home and they will be comfortable. | ||||||
Where would dog eat? |
We have Waffles bowls in our kitchen. We would likely place our new pups in the same area. | ||||||
Where would dog sleep: |
We have several dog beds throughout the house. During the day Waffles can sleep in one of the three dog beds, on our sofa, recliner, or our guest bed. In the evening we have a foam dog bed in our bedroom for her. We would likely get a second bed in our bedroom for the new pup for at night and they would have access to all other beds during the day. | ||||||
Play & exercise: |
We take Waffles on 2-3 walks a day, at least one of them longer. We also play fetch and other games with her throughout the day. We'd likely do the same with the new pup. | ||||||
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? |
We have a fully fenced in yard, but part of our gate is broken. Currently, we don't let Waffles outside in our yard without first reinforcing the gate and us being outside with her to keep an eye on her. | ||||||
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? |
|||||||
Lease allow dogs: |
|||||||
Landlord permission: |
|||||||
Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
We have two concrete patios with outdoor furniture and a small grassy yard. No other structures beside our garage. | ||||||
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? |
Tim Harkovich / Valerie Outman | ||||||
Willing to train children? |
N/A | ||||||
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, we are certainly willing to try. | ||||||
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} |