Untitled_1313 - Lakeshore Pembroke Welsh Corgi Rescue

Date & Referral Source
State:		Date of Application:	07/28/2017	Referred by:	Other
Contact Information
First name:		Last name:		First name 2:		Last name 2:
Address
Street:
City:			State:		Zip:
Type of Dog Wanted
Ages interested in:	1 year – 3 years	Gender preferred:	Either a Male or a Female	Color preferred:	Black Headed Tri, Any color	Activity level:	Couch Potato, Outgoing, Quiet
Other preferences:
Dog Ownership History
Previous dog owner?	Yes
	Dog 1
	Dog 1 name:
	Dog description:
	How long owned?
	Where is this dog now?
	Dog 2
	Dog 2 name:
	Dog description:
	How long owned?
	Where is the dog now?
	Dog 3
	Dog 3 name:
	Dog description:
	How long owned?
	Where is dog now?
	Dog 4
	Dog 4 name:
	Dog description:
	How long owned?
	Where is this dog now?
Questions Regarding Motivation for Adopting and Intentions
Who is this dog for?	Kim Swiatek
Why do you want a Pembroke?	The last dog we had was a corgi. He passed away from old age. We are looking to bring another one into our home because we love the companionship and loyalty of the breed.
Activities planned with Pembroke:	Our pembroke would have a big open yard to run around in. It would also travel with our family for camping trips and such.
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:
Will handle mistakes Pembroke makes like this:	With patience. We usually prefer to praise our animals for the good things they do. We use words and hand motions, but never hit our pets.
Discipline:	Words and hand motions. Never hitting.
Where would Pembroke spend the majority of the time:	We don't use cages or crates, so our pet would be free to roam around the house or our fenced in yard.
Discipline:	Words and hand motions. Never hitting. Where would Pembroke spend the majority of the time: We don't use cages or crates, so our pet would be free to roam around the house or our fenced in yard.
House dog or outside dog?	House dog
People at home during the day?	There is usually somebody at our house. If not, the pet would not be home alone for more than a few hours.
Where would dog eat?	In the past, our house animals have always had access to food inside the house.
Where would dog sleep:	In the house.
Play & exercise:	Our fenced in yard is very large and ready for running and playing. Our pets will have the opportunity to run and play whenever they go outside.
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?	Chain link fencing
Living arrangements:	Own home
Landlord info:
May we contact your landlord?
Lease allow dogs:
Landlord permission:
Restrictive covenants?	Not applicable
Breed/size restrictions?	No
Description of yard:	We have a swimming pool that is fenced in separately from the back yard. Other than that, the back yard is a small patio and grass.
Household members:
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?	Kim Swiatek
Willing to train children?	Yes
Any allergies?	No one is allergic.
Current pets:
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: