Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 09/06/2021 | 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: |
1 year – 3 years, 3 years – 5 years | Gender preferred: |
Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful |
Other preferences: |
Would love a dog who loves to cuddle. | ||||||
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? |
Barabara (me) | ||||||
Why do you want a Pembroke? |
Corgis are absolutely beautiful — I love their expressive faces. I also am attracted to corgis because of their intelligence. I have owned several dogs during my lifetime, but never a corgi. From what I have read, they are also very loyal and relatively low maintenance (aside from frequent brushing). | ||||||
Activities planned with Pembroke: |
My Pembroke Corgi and I would go on walks in my neighborhood and in the nearby prairie, a popular spot for all types of dogs and their people. We would also play fetch, and tug-of-war with toys. Honestly, we'd spend time sitting together watching tv, too. | ||||||
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: |
I would gently correct the mistake. | ||||||
Discipline: |
I believe in reinforcing good behavior instead of punishing bad behavior. I do not believe in yelling at a dog or striking it EVER. | ||||||
Where would Pembroke spend the majority of the time: |
My Pembroke would spend most of the time in my condo. The condo is relatively large (3 bedrooms) and is on the ground floor. The other 3 condos in the complex are back-to-back with no second floor. We each have a nice yard, too. | ||||||
Discipline: |
I believe in reinforcing good behavior instead of punishing bad behavior. I do not believe in yelling at a dog or striking it EVER. Where would Pembroke spend the majority of the time: My Pembroke would spend most of the time in my condo. The condo is relatively large (3 bedrooms) and is on the ground floor. The other 3 condos in the complex are back-to-back with no second floor. We each have a nice yard, too. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
I am retired and am home most of the time. I do not go out every day. When I do go out (for example, to get groceries or for a doctor appointment) I am never gone more than a few hours. | ||||||
Where would dog eat? |
My corgi would eat in the kitchen with me. | ||||||
Where would dog sleep: |
I would set things up so she'd be comfortable. So, if she felt secure sleeping in her crate, I would maintain that practice. If she wanted to sleep in bed with me, that would be wonderful! | ||||||
Play & exercise: |
She will get to walk and play every day with me. My daughter lives nearby and stops in most days — I'm sure she would keep the corgi active, too. | ||||||
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? |
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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? |
No, the condo covenants do not prevent me from having a dog. | ||||||
Breed/size restrictions? |
Yes | ||||||
Description of yard: |
My condo is on a corner lot. There isn't a fence but there aren't any swimming pools or other structures, either. | ||||||
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? |
Barbara (me) | ||||||
Willing to train children? |
I do not have small children or grandchildren. If a neighbor's child or grandchild wanted to see or pet my dog, I would teach the child how to approach my dog carefully, so they wouldn't startle or scare her. | ||||||
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? |
This is not an issue. | ||||||
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} |