Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 11/21/2020 | Referred by: | Other | ||
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: |
Any age | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Energetic |
Other preferences: |
Must get along with other dogs who like to play. Be housebroke. Bonus: Loves car rides, and sleeping in crate appx. 4hrs. | ||||||
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? |
Companionship. For Husbend & Wife household along with 2 Jack Russell sisters. | ||||||
Why do you want a Pembroke? |
Having Jack Russells I see a very similar disposition. I am a horse owner, and have interacted with them at numerous barns. I would love to own one! | ||||||
Activities planned with Pembroke: |
We live on 1 1/2 acres. Dogs run loose (under supervision). If not, they are on 50ft cables. We do go on walks approx. 2 blks away to the park and go through the wooded trails. I also take them (one at a time) to lake Michigan and Grant park for a great afternoon hike. | ||||||
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: |
Depends on the mistake! If he pee'd on the floor, I would let it go…maybe I did not see the "signs" he wanted to go out… If he walked right over to the other dog, demanded THAT toy, and there was a complete brawl…I would separate the two, the toy gets put on a shelf. One dog is going outside in the back yard to chill, the other out the front door to chill. I am sorry…it really depends on the situation. However, I would never beat, throw, kick, or harm them. I get rid of the toy (or buy 5 more). Now everyone has one. | ||||||
Discipline: |
Repetition. Repetition. Repetition. They know the drill. They know when it's breakfast, or supper. Fights, they get a time out. either in another room or outside. Or, a good walk. They hate when I am not happy with them. The dog in question, will slowly come out of the bedroom begging around the corner to join all of us on the couch. All I have to do is give him "the eye" and either they are not ready and go back into the room, or they slink up and give you kisses because they are sorry and want to be with everyone on the couch. | ||||||
Where would Pembroke spend the majority of the time: |
Anywhere in the entire house. | ||||||
Discipline: |
Repetition. Repetition. Repetition. They know the drill. They know when it's breakfast, or supper. Fights, they get a time out. either in another room or outside. Or, a good walk. They hate when I am not happy with them. The dog in question, will slowly come out of the bedroom begging around the corner to join all of us on the couch. All I have to do is give him "the eye" and either they are not ready and go back into the room, or they slink up and give you kisses because they are sorry and want to be with everyone on the couch. Where would Pembroke spend the majority of the time: Anywhere in the entire house. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
No. But I come home at lunch from work (11:30) to let everyone out. Then my husbend is home at 3:00pm and lets them out. Then I come at 3:30pm and give them a good run in the yard. | ||||||
Where would dog eat? |
All dogs get fed in a different room. He would be fed in one of the bedroom's in peace and quiet. | ||||||
Where would dog sleep: |
Probably in bed with me and the rest of the dogs! Otherwise, it's the dog's preference. | ||||||
Play & exercise: |
Like I said, he would have full run of the house, playmates to run with, 1 1/2 acres to run on, otherwise, 50ft cable. Cable goes down to 25 ft in the winter because of coyotes in the yard. | ||||||
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: |
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: |
|||||||
Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
1 1/2 acres. Above ground swimming pool. I do have the dogs swim with me, but they have life jackets on. | ||||||
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? |
Jennel A Kordus | ||||||
Willing to train children? |
yes. I have grandchildren. They already know how to respect animals. But, my dogs don't get to see them or children often, so that's where walks are benificial because they will see them in the park. | ||||||
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 | ||||||
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} |