Adoption App 12345678 Page One: Applicant InformationDate* MM slash DD slash YYYY Applicant 1Applicant 1 Name* First Last Phone 1* Phone 2 Do you have an email address* Yes No Email Address Enter Email Confirm Email Occupation* Applicant 2Applicant 2 Name First Last Applicant 2 Phone 1 Applicant 2 Phone 2 Applicant 2 Email Address Enter Email Confirm Email Applicant 2 Occupation Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Who is this Pembroke for?*Referred by* Website Friend Breeder Veterinarian Other Desired Pembroke QualitiesAge*Check the box next to all age ranges you will consider adopting from. 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* Male Female Either a Male or a Female Color*Put a check by every color you will consider. Please go to this link to see what the various options look like: http://www.pembrokecorgi.org/colors.html Red & White Red Headed Tri Black Headed Tri Sable & White Any color Desired Activity Level*Check the box next to every activity level you will consider. Couch Potato Outgoing Quiet Playful Energetic Very Active Other (Please describe in the box below.) Describe "other" activity level you desire.Other considerations Canine Ownership HistoryDo you own one or more dogs currently?* Yes No Have you owned a dog before? (As and adult, living on your own)* Yes No List the dogs you have owned. List the most recent or current dog(s) first.Dog nameBreedLength of time ownedDo you still have this dog?Where is this dog now if you no longer have it? Breed QuestionsWhy do you want to adopt a Pembroke Welsh Corgi? Please be specific. If you love the breed, what do you love about it? What have your experiences with the breed been? Have you done research on the breed?*What kinds of activities would you do with your Pembroke?*Pembrokes are often very active, vocal, busy dogs that enjoy being with people and insist on receiving a great deal of affection. Are you prepared to live with a dog like this?* Yes No Taking care of a dog costs quite a bit of money and takes time. Experts estimate that it can cost between $1000 and $1500 per year depending on where you live. That doesn't include emergency medical care and older pets will generally incur higher medical costs. Are you able to provide a Pembroke with adequate food, shelter and medical care?* Yes No In addition to basic medical care like a yearly physical, shots, flea/tick and heartworm medication, your Pembroke may become ill and need expensive medical treatment. Are you able to afford an unexpected medical expense that could be in the thousands of dollars?* Yes No Even if the Pembroke has been previously house trained, you should expect that it will not be house trained at first in a new home. This may be temporary, or it may require training. Would you be willing to house train a Pembroke?* Yes No Are you wiling to formally train your Pembroke, including obedience classes?* Yes No Veterinarian InformationDo you have a veterinarian?* Yes No Veterinarian's Name Veterinarian's Clinic Name Veterinarian's Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please list your veterinarian's website below. Care & Training QuestionsIf the Pembroke makes a mistake, how would you handle it?*What methods of discipline do you use with a dog?*Where would your Pembroke spend most of his or her time?*Would the Pembroke be a house dog or would it be an outside dog?* House dog Outside dog Are there people home during the day at your house?*Where would the Pembroke stay during the day?*Where would your adopted corgi eat?*Where would your adopted corgi sleep?*How will you provide your adopted corgi with opportunities to play and exercise? How much will he/she get to play and exercise?*Dogs may run off and roam if given the chance. How do you plan to exercise your adopted corgi?* On leash Restrained to the yard Both on leash and restrained to the yard Do you have a fenced in yard?* Yes, I have a fenced in yard. No, I don't have a fenced in yard. Please describe your fence.Most communities require dog owners to pick up their pet's waste. Are you willing to always keep a supply of bags with you and to do this?* Yes, I will clean up after my dog. No, I will not clean up after my dog. Dogs may become destructive or make messes in the house when left alone, but there are ways to train them not to chew or mess in the house. Are you willing to take the time and effort to train your adopted corgi? Are you willing to use a pen or crate to solve these problems?* Living ArrangementsDescribe your living arrangements:* Own home Rent/lease home Landlord Name First Last Landlord PhoneLandlord Email May we call your landlord to confirm his/her willingness to allow a dog? Yes, you may contact my landlord. No, you may not contact my landlord. Does your lease permit dogs* Yes, my lease permits dogs. No, my lease does not permit dogs. Has your landlord consented to you owning a Pembroke? Yes, my landlord is fine with me owning a Pembroke No, my landlord has not given me permission to adopt a Pembroke If you live in a condo or town home, are there any restrictive covenants that prevent you from owning a dog?* No, the condo covenants do not prevent me from having a dog. Yes, the condo covenants do prevent me from owning a dog. Not applicable Are there any restrictions on the types or size of dogs you can own where you live?* Yes No If you live in a house, describe your yard including any fixtures like swimming pools.*May a LPWCR representative visit/inspect your home before you adopt a Pembroke and during the adoption process?* Yes, I will allow LPWCR representatives to inspect my home prior to allowing me to adopt a Pembroke. No, I will not allow LPWCR representatives to inspect my home prior to allowing me to adopt a Pembroke. Household QuestionsDescribe all of the people who live in your home.NameAgeInterests Is everyone in your family in agreement about adopting a Pembroke Welsh Corgi?* Yes, everyone agrees and wants to adopt a Pembroke Welsh Corgi. No, some members of the family do not want to adopt a Pembroke Welsh Corgi Name of the person who is primarily responsible for caring for the Pembroke - walking, feeding, grooming, etc.* Children do not come into the world knowing how to treat animals, are you willing to take the time to teach your child how to humanely care for animals?*Are you absolutely certain no one in your household is allergic to dogs?* No one is allergic. One or more family members might be allergic to dogs. Do you own a cat or other smaller animal who run loose in the house?* Yes No Describe all of the pets that live in or spend significant time in your home.NameSpeciesAgeNeutered? (Indicate yes or no) Are all of the above listed pets friendly toward dogs? Yes, all of our current pets are friendly toward dogs. No, some of our current pets are not friendly toward dogs Are you willing to try to resolve the problem if your newly adopted Pembroke doesn't get along with your current pets or other pets you may add in the future?*Are you willing to take responsibility for your adopted Pembroke for the rest of its life?* Yes, I am willing to commit to this dog for the rest of its life. No, I am not willing to commit to this dog for the rest of its life. If, for any reason, you are not able to take care of your adopted Pembroke for the rest of its life are you willing to return the Pembroke to LPWCR?* Yes, I will only surrender my adopted corgi to LPWCR if I am unable to care for it. No, I am not willing to agree to surrender my adopted corgi to LPWCR if I am unable to care for it. Do you understand that there are no guarantees as to the condition, health, behavior or personality of the Pembroke you adopt, and that LPWCR makes no claims or representations as to the health, behavior, or personality of this Pembroke?* Yes, I understand that there are no guarantees regarding the condition, health, behavior or personality of the Pembroke I adopt. No. Have you given this adoption thorough consideration and taken into account the many things that can go wrong when you adopt a pet?* Yes, I have carefully thought out my decision to adopt a Pembroke and am willing to deal with the consequences. No, I haven't really given this much thought at all. List at least 2 personal references who are not relatives.*NameRelationship with applicantPhone 1 (Include area code)Phone 2 (Include area code)Email Adoption Stipulations and DisclaimersWe welcome and appreciate your interest in providing a good home for a Pembroke. Please understand that your completion of this application does not guarantee that a suitable Pembroke will be found for you. Please also understand that applicants are not placed on a waiting list in order of the dates of their applications, but rather that in each case of selecting a home for a Pembroke all applications will be considered equally in order to attempt to select the most suitable home for that Pembroke in light of its health, personality, behavior and other factors. In the event that a Pembroke were to be considered for adoption by you, there would be a written agreement between you and LPWCR, and LPWCR might visit your home. In this agreement, among other things, you will make certain pledges regarding your care of the Pembroke, and you would agree that the Pembroke must be returned to LPWCR if you are unable to fulfill the terms of the agreement or if you no longer want or could no longer take care of the Pembroke. Please understand that LPWCR cannot make any guarantees regarding the future health or physical condition of the Pembroke, and that all expenses (including medical expenses) subsequent to adoption of the Pembroke would be your responsibility. The Pembroke will be spayed or neutered before adoption. There is an adoption donation fee between $250 and $350 (depending on the age of the dog) from you to LPWCR to defray expenses relating to LPWCR’s vetting and care of the Pembroke prior to the adoption. LPWCR would appreciate notification if, after you complete the Application for Adoption and are waiting for a response, you get another dog or decide that you no longer wish to adopt a Pembroke. All applications are stored on a secure server where only foster homes and the board have access.NameThis field is for validation purposes and should be left unchanged.