Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 07/29/2021 | 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: |
0 months – 1 year (we rarely get dogs in this age group), 1 year – 3 years, 3 years – 5 years, 5 years – 10 years, 10 years +, Any age | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Energetic, Very Active |
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? |
For us. | ||||||
Why do you want a Pembroke? |
We currently have a 1 year old Pembroke Welsh Corgi called Wally. We both love the breed. A big dog in a small package. Wally was our first corgi, and while we researched, we learned a lot just by having him home with us. We love how intelligent they are, how goofy, loyal and snuggly. Wally never fails to make us laugh daily with his antics. Watching his play or try to herd is our favorite thing about them. | ||||||
Activities planned with Pembroke: |
Long walks, dog parks, swimming, herding initiation trials, barn hunts | ||||||
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: |
Identify the issue and do positive reinforcement training if necessary. As a puppy, Wally chewed many pairs of shoes. Not his fault, our fault for allowing him access and it also indicated that he was bored. So we changed our routine and made sure we were meeting his needs physically and mentally. We would do the same with any dog that enters our home | ||||||
Discipline: |
We have never disciplined our dog or needed to. If when playing with either us or another dog and they get too rambunctious, we would recall them and redirect. If they are still too high energy, we would crate or put them in an x-pen to give them a quiet safe space to reset. | ||||||
Where would Pembroke spend the majority of the time: |
Our family home. They would have full run of our 1500sqft house. | ||||||
Discipline: |
We have never disciplined our dog or needed to. If when playing with either us or another dog and they get too rambunctious, we would recall them and redirect. If they are still too high energy, we would crate or put them in an x-pen to give them a quiet safe space to reset. Where would Pembroke spend the majority of the time: Our family home. They would have full run of our 1500sqft house. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes. My schedule is very flexible and although I do have to go into the lab, I am gone no longer than 6 hours at a time. | ||||||
Where would dog eat? |
On the main level of our house. Both dogs would be fed separately to avoid any resource guarding behaviour. | ||||||
Where would dog sleep: |
In bed with us (that's where our current corgi sleeps) but we have a ramp for our bed so if they wish, they can sleep on a dog bed in our bedroom. | ||||||
Play & exercise: |
At least one 30 minute walk in the morning, then 1hr at a dog park in the evening. Alternatively, we would go on an hour long walk in the evening to let them sniff and get their energy out. We also play at least 30mins regularly with our current dog (fetch is his current favorite). | ||||||
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: |
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Landlord permission: |
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Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
We have a small yard that we are planning on getting fenced in. However we have plenty of trails and walkways nearby so that our dogs can roam outside with us on leash. | ||||||
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? |
Louise Reilly | ||||||
Willing to train children? |
N/A as we do not plan to have children | ||||||
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? |
Yes. Slow introductions and lots of positive reinforcement to make sure both pets are happy | ||||||
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} |