Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 04/20/2021 | Referred by: | Website, 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: |
3 years – 5 years, 5 years – 10 years | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Quiet, Playful, Other (Please describe in the box below.) |
Other preferences: |
Our family is made up of older children (12+), but sometimes have visitors with younger children. We enjoy frequent walks and occasional long hikes. | ||||||
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? |
Our family. Our daughter especially has been interested for a long time in having a dog and we have decided it would benefit her to have that companionship. However, he/she will be a family dog and we will all love and care for him/her. I (Cindy) will take primary responsibility. | ||||||
Why do you want a Pembroke? |
A friend who knows our family well and has had dogs all her life recommended Corgis to us. I began researching and found that the descriptions were in line with our reasons for adopting a dog, especially companionship (we are home during the day and one of our main reasons for adopting a dog is companionship, especially for our daughter). | ||||||
Activities planned with Pembroke: |
We would snuggle as often as the dog wants, go for walks multiple times a day using different routes, play fetch, tug (with proper training), occasional hikes, possibly jogging. We are also open to learning activities that are especially good for Pembrokes (some I've read about are playing with a herding ball, a flirt pole, and various tracking games/activities). We also would like to take our dog to visit our elderly friends if that ends up to be a fit. | ||||||
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: |
We would address it immediately, redirecting as much as possible. For example, if the Pembroke is chewing on something that is not acceptable, we would give him/her an acceptable chew toy and praise for chewing on that. | ||||||
Discipline: |
Positive reinforcement with rewards that the individual dog finds rewarding (i.e. praise, a toy, play a game) | ||||||
Where would Pembroke spend the majority of the time: |
In our home near us. If the dog needs time alone to rest, we would make a spot for him/her free from distraction but still where we can keep an eye on him/her. When we go outside, we would take the dog with us to get fresh air and exercise. | ||||||
Discipline: |
Positive reinforcement with rewards that the individual dog finds rewarding (i.e. praise, a toy, play a game) Where would Pembroke spend the majority of the time: In our home near us. If the dog needs time alone to rest, we would make a spot for him/her free from distraction but still where we can keep an eye on him/her. When we go outside, we would take the dog with us to get fresh air and exercise. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes, there are generally 3-6 people home all day. Saturday morning, for about 3 hours, is the only consistent time there is no one home. We realize this will take training and effort for the dog to adjust to these times. | ||||||
Where would dog eat? |
Most likely in the room on the side of our kitchen, but we would adjust if needed. | ||||||
Where would dog sleep: |
Near us in our home. We plan to use a spot that the dog feels comfortable and use a crate or pet bed (whichever ends up better for the dog). | ||||||
Play & exercise: |
Multiple times a day we will take him/her for walks, take outside to play if the weather is suitable, and play inside. | ||||||
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: |
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: |
|||||||
Landlord permission: |
|||||||
Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
We have a 1.5 acre lot. Clockwise around the house: the front yard has a few trees and flowerbed. The side yard has the septic and propane tank. The back yard has a medium-size shed where we store the lawn mower, etc. Next to the shed is our chicken coop. There is an existing dog kennel attached to the shed which we would use only when necessary for keeping our dog safe outside. There are also a couple of raised bed gardens, grapevine, and more trees. The other side yard is more open with trees bordering it and a flower bed along the side of the house. | ||||||
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? |
Cindy Greene | ||||||
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} |