Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 01/01/2021 | 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: |
Any age | Gender preferred: |
Either a Male or a Female | Color preferred: |
Red & White, Red Headed Tri, Black Headed Tri, Sable & White, Any color | Activity level: |
Couch Potato, Quiet, Playful |
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? |
Lisa Meinhart | ||||||
Why do you want a Pembroke? |
Have owned/adopted corgis in the past. Great breed! Happy playful dogs. | ||||||
Activities planned with Pembroke: |
Indoor play/outdoor play. We have a fenced yard and our dogs love to play with other dogs. | ||||||
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: |
Naughty behavior . Their attention is redirected to better behavior, then praise. | ||||||
Discipline: |
Clicking of tongue or clapping. Sometimes stomping feet on floor. | ||||||
Where would Pembroke spend the majority of the time: |
Inside mostly, but out when she/he wants. Our current pups like outside best, so we let them out a lot. When we are outside, they are always with us. We'd let the dog decide. | ||||||
Discipline: |
Clicking of tongue or clapping. Sometimes stomping feet on floor. Where would Pembroke spend the majority of the time: Inside mostly, but out when she/he wants. Our current pups like outside best, so we let them out a lot. When we are outside, they are always with us. We'd let the dog decide. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes. Kim is retired. Lisa works from home. | ||||||
Where would dog eat? |
The dogs have their own room. Just off the kitchen. Food bowls and water are in there. They eat and then they come out to the living area. Their beds, toys are kept in there. When pups are inside, they bring whatever toys they want to play with into whatever room we are in and we play. | ||||||
Where would dog sleep: |
Wherever he/she wants. There will be a bed in the dogs room. They are permitted to sleep in the living room or in our rooms. Usually though our dogs put themselves to sleep in their room when they are ready. | ||||||
Play & exercise: |
We play with our dogs mostly at night. During the day, they can go outside and run in our fenced yard. They tend to poop themselves out pretty quickly, but are ready to play adinner. After dinner. | ||||||
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? |
The yard is large. One side is bordered by the house and garage, two sides are bordered by a six ft. tall wood fence. The last side is a four ft. chain link. Our neighbors asked us not to put a wood fence along that side of the yard because their dogs love to run along the fence line with our dogs and they play. | ||||||
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: |
Yard described above. There are a lot of trees and a huge doghouse. The dogs have access (via doggie door) into a fenced area in the garage. They are not able to reach anything hazardous in the garage and we do not keep rodent poison anywhere.. No pool. The front yard is very large, but without a fence and dogs are leashed out there. | ||||||
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? |
Lisa | ||||||
Willing to train children? |
No kids around here. | ||||||
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? |
Absolutely. There will always be adjustment time. We have always had our critters get along. | ||||||
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} |