Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 03/18/2021 | 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: |
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 preferences: |
|||||||
Dog Ownership History | |||||||
Previous dog owner? |
No | ||||||
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? |
Myself! | ||||||
Why do you want a Pembroke? |
Pembroke Welsh Corgis are adorable and a small to medium sized dog. It would be very appropriate for my living situation since I am in an apartment complex. I also like how they are moderately active. I am active myself, and would love to go for walks with some company who also likes to stay active. I also love how corgis are social and enjoy human interaction. Unfortunately, I never lived with dogs because my parents are allergic, but I grew up with different dogs from extended family and friends. | ||||||
Activities planned with Pembroke: |
As mentioned earlier, I would love to go for walks with a dog who also enjoys going for walks. I also live by a dog park, so the Pembroke and I will be going to the dog park often and play outside. Another big thing that will happen is the training, especially when first introduced to my home, so the Pembroke can get used to the new setting. Lastly, I would enjoy some nights to pet and chill with my Pembroke. | ||||||
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: |
I would calmly, but firmly tell them "no" to the adopted Pembroke. I would promptly do this, so they know and learn to understand that it is a mistake and should not occur. | ||||||
Discipline: |
I think the first step would be establishing a daily routine, so they understand what time it is to eat, when its time for a walk, time to sleep etc. Any misbehavior can be correctly but calmly and firmly stating "no" any time the dog needs to be disciplined, being consistent and and prompt with it. A positive reinforcement would also be used if they produce a good behavior by giving them a treat. | ||||||
Where would Pembroke spend the majority of the time: |
They would spend most of their time in my apartment either in my room or the living room. | ||||||
Discipline: |
I think the first step would be establishing a daily routine, so they understand what time it is to eat, when its time for a walk, time to sleep etc. Any misbehavior can be correctly but calmly and firmly stating "no" any time the dog needs to be disciplined, being consistent and and prompt with it. A positive reinforcement would also be used if they produce a good behavior by giving them a treat. Where would Pembroke spend the majority of the time: They would spend most of their time in my apartment either in my room or the living room. |
||||||
House dog or outside dog? |
House dog | ||||||
People at home during the day? |
It varies. My roommate works from home from time to time and I come home from lunch during the work week sometimes. | ||||||
Where would dog eat? |
In the kitchen | ||||||
Where would dog sleep: |
The adopted corgi will sleep in my room. | ||||||
Play & exercise: |
I will provide my adopted corgi with time to play and exercise probably before work and after work. I exercise daily, so I would go on walks for 20-30 minutes every day. I also live by a dog park, so I can bring the adopted corgi there to play for half an hour if necessary. | ||||||
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: |
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? |
|||||||
Lease allow dogs: |
|||||||
Landlord permission: |
|||||||
Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
Yes | ||||||
Description of yard: |
I currently live in an apartment complex. | ||||||
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? |
Monica | ||||||
Willing to train children? |
I do not have a child. | ||||||
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? |
I am willing, but I am only planning on having one dog for awhile. | ||||||
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} |