Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 03/10/2021 | Referred by: | Friend | ||
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: |
1 year – 3 years, 3 years – 5 years, 5 years – 10 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: |
I would love it if the dog was housetrained and ideally basic commands. I dont have any other dogs at home but my family (parents, sisters [all adaults]) does and I would like to be able to bring my dog to family events with the other family dogs. I'd ideally like a dog that I would be able to have as an ESA dog that I could have with me on flights back to NJ once or twice a year. I'd also like the dog to be okay if we went for car rides. |
||||||
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? |
Marissa Sbrilli | ||||||
Why do you want a Pembroke? |
The breed is a good fit for energy level (energetic enough to hang outside and go on walks/maybe low key "hikes" with me) and disposition. The size is perfect and similar to what I have had in the past. I like that they are smart and are easily trained. I have not owned a corgi myself but I had a roommate with a corgi and plenty of friends with them. I appreciate that they are very sociable dogs (in my experience). I like dogs that are love sponges and are interested in my loving up on them! | ||||||
Activities planned with Pembroke: |
walks, low key hikes (i.e., the Illinois version of hikes – so nothing steep/treacherous). We would play with toys in the house and bakyard (on a lead with me). During th day, the dog with be with me in the house and I would be happy to have the pyup at my feet or lap as I work so I could keep spoiling the little nugget. | ||||||
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? |
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: |
If I saw it happening I would say, "no" firmly. Fix up the area then give positive reinforcement next time when they don't make the mistake. | ||||||
Discipline: |
verbal "no." Crate if that is how the dog is trained. |
||||||
Where would Pembroke spend the majority of the time: |
with me in the first floor of the house. At night, option to sleep with me in the bedroom/bed or on first floor (coming and going as the dog pleased- if age/training appropriate) | ||||||
Discipline: |
verbal "no." Crate if that is how the dog is trained. Where would Pembroke spend the majority of the time: with me in the first floor of the house. At night, option to sleep with me in the bedroom/bed or on first floor (coming and going as the dog pleased- if age/training appropriate) |
||||||
House dog or outside dog? |
House dog | ||||||
People at home during the day? |
yes – I work from home | ||||||
Where would dog eat? |
in the kitchen/dining area | ||||||
Where would dog sleep: |
At night, option to sleep with me in the bedroom/bed or on first floor (coming and going as the dog pleased- if age/training appropriate). I'm the kind of pet parent where there will be dog beds everywhere just in case they want it. |
||||||
Play & exercise: |
walks (~10-15mins) every morning, and evening. and at lunch if the dog is interested. On the weekends walks could be longer (~1-2 hrs) if the dog has the energy for it | ||||||
How will you exercise your dog? |
On leash | ||||||
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? |
|||||||
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: |
it san open backyard (no fence). it just has a few trees and a locked shed. no pool. There is a fire pit out back but its not going to be lit or anything when the dog is out. | ||||||
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? |
Marissa Sbrilli | ||||||
Willing to train children? |
No children in the house. I will not be a parent to a human, only dogs! |
||||||
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? |
|||||||
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} |