Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 12/14/2020 | 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: |
0 months – 1 year (we rarely get dogs in this age group), 1 year – 3 years, 3 years – 5 years | Gender preferred: |
Either a Male or a Female | Color preferred: |
Red & White, Red Headed Tri, Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful |
Other preferences: |
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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 corgi would be taken care by me, and my roommate would help take care this corgi. She is also a Registered Nurse, but works night shift, thus someone would be home at all times with the corgi. | ||||||
Why do you want a Pembroke? |
I've always wanted a dog growing up. My parents would never let us having one, but whenever I went to friends houses you'd most likely find me playing with the dog rather than the actual humans I went to see. I've also had some experiences dogsitting for some Pembrokes thankfully and gotten along with them. These were more energetic and loved going on walks, but this was also during the summertime. I have done some research on the breed, and I'm willing to make necessary changes to life to accomodate for the care of him/her. | ||||||
Activities planned with Pembroke: |
My roommate and I love going for hikes and long walks on our days off that we both have. If not, i'd take the Pembroke on a trip and go for long walks. Our apartment complex is very pet friendly, even has a leash free dog park to play in during the warmer weather. | ||||||
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: |
I'd mostly likely speak in a stern voice, but attempt to teach a good behavior or fix the behavior and give a reward to treat the good behavior. | ||||||
Discipline: |
If the dog were to need discipline, I'd put the dog in his little kennel for a time out. If it was for attention seeking, I'd "ignore" the dog and wait for appropriate behavior and reward it for doing a good/positive behavior. | ||||||
Where would Pembroke spend the majority of the time: |
We have 1200 sq ft to our apartment. This corgi would have access to my bedroom and our living room space/dining room and kitchen. | ||||||
Discipline: |
If the dog were to need discipline, I'd put the dog in his little kennel for a time out. If it was for attention seeking, I'd "ignore" the dog and wait for appropriate behavior and reward it for doing a good/positive behavior. Where would Pembroke spend the majority of the time: We have 1200 sq ft to our apartment. This corgi would have access to my bedroom and our living room space/dining room and kitchen. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes! My roommate works night shift and I work day shift. So someone is typically home. Whether it be my day off or my roommate is not working and taking naps. | ||||||
Where would dog eat? |
As for diet, I'd have to consult my vet friend about it. But my roommate has some history with dogs and what they eat. Ideally I'd want to provide as much fresher food options on top of the dry foods/wet foods we can buy at the store. | ||||||
Where would dog sleep: |
I have a space next to my bed and window in my room for my Pembroke to sleep, but also there is space in our living room for a dog bed if he/she chooses to want to sleep there. | ||||||
Play & exercise: |
My roommate and I love going on long walks/hikes on our days off together. We also have leash free dog park in our complex for dogs to play in. Our apartment has an open concept, and would make a great mini running space for our dog to have "zoomies". | ||||||
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: |
Apartment Complex | ||||||
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: |
N/A | ||||||
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? |
Anthony Huynh | ||||||
Willing to train children? |
Don't have any children, but would love to teach kids how to be gentle if we do experience one. | ||||||
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} |