Untitled_3899

Applicant IL
State: {Applicant State:2} Date of Application: 08/01/2021 Referred by: Website
First name: {First Name:98} Last name: {Last Name:97} First name 2: {First Name 2:94} Last name 2: {Last Name 2:93}
Street: {Street Address:3}
City: {City:4} State: {State:5} Zip: {Zip:6}

Ages interested in:
 3 years – 5 years, 5 years – 10 years
Gender preferred:
 Either a Male or a Female
Color preferred:
 Red & White, Any color
Activity level:
 Couch Potato, Quiet, Playful, Other (Please describe in the box below.)

Other preferences:
 Need new friend to be housebroken, sweet, and calm in order to maneuver walkers/cane and ramps in house for human companion.

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}

Who is this dog for?

 Bill – he lost his corgi rescue companion earlier this year and is very much wanting to spend his time with another furry buddy for snuggling, watching birds, car rides, and conversation.

Why do you want a Pembroke?
 Bill recently lost his 13 year old corgi mix rescue. Her name was Annie and she was his daily companion for talking, bird watching, tv watching, and meals. She took an extra special place in his daily activities after his Wife died in December.
Annie had a cancer removed a few years ago and what appeared to be a regrowth of the tumor recently. The doctor determined she likely had internal bleeding when she arrived to them and ultimately the decision was made to have her journey with my father end. He is broken-hearted as we are for him!!
I don’t know how likely it is that a rescue or surrendered dog comes your way from another elderly caregiver, but I thought I’d reach out in case. Ideally the next dog he adopts will be housebroken, mature, and enjoy a slower pace for companionship. Annie was a good barker up until her last days and was able to alert my father if somebody was entering his property or home. She wasn’t too small and was able to maneuver with walkers and canes. This was useful! She also tolerated the queen cat of the house, Odessa.

Activities planned with Pembroke:
 Snuggling, talking, nature watching, feeding birds, gentle play(fetch), car rides, etc.

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?

 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: 		Change of voice tone if correction needed at the time it happens, practice of desired behavior, ignore mistake if not significant.

Discipline:
 Scold or crate time out.

Where would Pembroke spend the majority of the time:
 By Bill’s side (at home lounging indoors, exploring outdoors, short car trips)

Discipline:
 Scold or crate time out.
Where would Pembroke spend the majority of the time: By Bill’s side (at home lounging indoors, exploring outdoors, short car trips)

House dog or outside dog?

 House dog

People at home during the day?
 Yes

Where would dog eat?
 In the living room next to Bill’s lift chair.

Where would dog sleep:
 In Bill’s room, beside the bed, or wherever he/she feels most comfortable.

Play & exercise:
 Daily small trips around the house in fenced back yard or driveway walks. Toy toss or hide-and-find toy activities for extra stimulation. (Bill’s daughter can introduce dog puzzles or yard games that are low human impact but high dog activity)

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?
 4foot chain link fence in back yard with cable at bottom to prevent digging/pushing under by dog.

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:

 No swimming pool. Back yard is fenced. Open yard has natural woods/brush barrier on 3 sides, pretty secluded set off road)

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?
 Bill

Willing to train children?
 No children in family or likely to visit, but yes, if need arises.

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

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}