Date & Referral Source | |||||||
State: | Date of Application: | 12/02/2017 | Referred by: | Friend | |||
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: |
Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Energetic, Other (Please describe in the box below.) |
Other preferences: |
Will train if not house broken. Good temperament to use possibly as a therapy dog. | ||||||
Dog Ownership History | |||||||
Previous dog owner? |
Yes | ||||||
Dog 1 |
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Dog 1 name: |
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Dog description: |
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How long owned? |
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Dog 2 | |||||||
Dog 2 name: |
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Dog description: |
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How long owned? |
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Where is the dog now? |
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Dog 3 | |||||||
Dog 3 name: |
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Dog description: |
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How long owned? |
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Where is dog now? |
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Dog 4 | |||||||
Dog 4 name: |
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Dog description: |
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How long owned? |
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Where is this dog now? | |||||||
Questions Regarding Motivation for Adopting and Intentions | |||||||
Who is this dog for? |
Deborah Wilson | ||||||
Why do you want a Pembroke? |
I've always loved the breed, they're smart and learn quickly. Good temperament. I love the smaller stature. They love affection and I love giving it. They are great companions, people person dogs. | ||||||
Activities planned with Pembroke: |
Walks, dog parks for running. Also take with me for therapy dog. I live in the country so there's plenty of open areas to explore together. Obedience scjool and agility classes. | ||||||
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? |
No | ||||||
Vet contact info: |
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Will handle mistakes Pembroke makes like this: |
I'm going to use verbal commands, in conjunction with American Sign Language. I'm fluent in sign language although I'm hearing. | ||||||
Discipline: |
Positive reinforcement, clicker training. Reward good behaviors. I would also seek the knowledge of a trainer. | ||||||
Where would Pembroke spend the majority of the time: |
Right with me in my home and where ever I can take her I will. I love the companionship of a dog. | ||||||
Discipline: |
Positive reinforcement, clicker training. Reward good behaviors. I would also seek the knowledge of a trainer. Where would Pembroke spend the majority of the time: Right with me in my home and where ever I can take her I will. I love the companionship of a dog. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes, I'm retired and generally spend a good amount of time at home. I also will take her with me whenever possible. | ||||||
Where would dog eat? |
A mixture of dry and wet foods, Wellness | ||||||
Where would dog sleep: |
In my bed next to mommy!! | ||||||
Play & exercise: |
I love to walk. I live in the country. Plenty of open spaces. I will also take her to dog parks we have several not to far from home. She will be enrolled in agility classes as well. I will teach her to fetch the ball and exercise her several times a day. I know they need to run off energy | ||||||
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: |
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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: |
Country setting 3 acres. 1 acre of mowed grass. No.pools. | ||||||
Household members: |
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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? |
Deborah Wilson | ||||||
Willing to train children? |
N/A | ||||||
Any allergies? |
No one is allergic. | ||||||
Current pets: |
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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? |
N/A | ||||||
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: |