Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 02/07/2021 | 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: |
Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Other (Please describe in the box below.) |
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? |
We would like to adopt a Corgi for my husband and me as a way to start our family:-) | ||||||
Why do you want a Pembroke? |
My husband and I have had an affinity for Welsh Corgis for several years. Not only do we love their appearance but their personalities are what really draws us to this breed. From our research, we understand them to be affectionate, playful, and intelligent. We plan to have kids soon so a dog that is kid/family friend is a must. We appreciate that they are adaptable to different living situations. We also love their ability to connect with strangers. We enjoy hosting family and friends and want our guests and dog to be comfortable with one another. The two Corgis we've been exposed to personally captured our hearts instantly. One was my husband's coworker who brought her Corgi in and would take turns laying by people's feet and was so endearing. The other was one of my best friend and her husband's rescue Corgi who we had a blast playing with, taking to breweries, and snuggling with while visiting them. We also follow more Corgis on social media than an other breed and has become our nightly ritual to look through them all and watch their stories/posts imagining one day, we'll have that joy of our own. |
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Activities planned with Pembroke: |
We live in a northern suburb of Chicago near Lake Michigan in a very safe neighborhood. We will take our dog on walks around the neighborhood, to local dog parks, and to the beach.
We will make sure it gets plenty of attention and playtime indoors as well with a great space to run around and chase in the basement or on the first floor which has a great circle layout that our nephew loves to run around in. |
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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: |
Redirect the bad behavior towards a positive one. ie. pees in the wrong spot, show where good spot is or how to alert us. If it chews on something its not suppose to, give it a toy it can chew on, etc. | ||||||
Discipline: |
Primarily positive reinforcement and training. | ||||||
Where would Pembroke spend the majority of the time: |
Likely on the couch with us in the family room either while I work during the day or while we watch TV at night. | ||||||
Discipline: |
Primarily positive reinforcement and training. Where would Pembroke spend the majority of the time: Likely on the couch with us in the family room either while I work during the day or while we watch TV at night. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes – both my husband and I work from home and plan to have at least one of us at home every day even after COVID. | ||||||
Where would dog eat? |
In the kitchen or dining room where we would have dog bowl | ||||||
Where would dog sleep: |
In a doggy bed in our bedroom | ||||||
Play & exercise: |
We will take it on daily walks in the morning and evening. We will also incorporate playtime throughout the day in our back yard or inside on particularly cold days. | ||||||
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? |
8ft tall wood fence with gates | ||||||
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: |
Our back yard has an area of grass that runs along the back side of the house as well as some cement area for patio furniture. | ||||||
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? |
April | ||||||
Willing to train children? |
Yes | ||||||
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? |
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} |