Untitled_1650 - Lakeshore Pembroke Welsh Corgi Rescue

Date & Referral Source
State:		Date of Application:	02/15/2018	Referred by:	Website
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, 3 years – 5 years	Gender preferred:	Either a Male or a Female	Color preferred:	Any color	Activity level:	Couch Potato, Outgoing, Quiet, Playful, Energetic
Other preferences:
Dog Ownership History
Previous dog owner?	No
	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?	It is for myself and my children as our first family pet
Why do you want a Pembroke?	We desire a Pembroke Welsh Corgi because of the looks, temperament, size, and intelligence of the breed. My children are 15 and 9 and each have different desires from a dog. One wants a cuddle buddy and the other wants to play. Based on the research I have done, this breed fits both those desires.
Activities planned with Pembroke:	Walks, playing in the 1.5 acre yard, car rides, dog park, and snuggling in the house.
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?	No
Vet contact info:
Will handle mistakes Pembroke makes like this:	Move on from the mistake if it is in the past and not caught in the action. Continue to promote and reward the good behaviors with treats and positive reinforcement.
Discipline:	A clap of the hands or a firm "no" at the moment of the bad behavior. Remove the dog from the situation or activity if needed.
Where would Pembroke spend the majority of the time:	In the house during working hours and outside for potty and playtime afterwards.
Discipline:	A clap of the hands or a firm "no" at the moment of the bad behavior. Remove the dog from the situation or activity if needed. Where would Pembroke spend the majority of the time: In the house during working hours and outside for potty and playtime afterwards.
House dog or outside dog?	House dog
People at home during the day?	Every other week someone is home all day.
Where would dog eat?	Near the kitchen area where we eat
Where would dog sleep:	If trusted on a dog bed in the bedroom. If not trusted, in a crate.
Play & exercise:	Daily exercise for at least 30 min outside.
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?
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:	Ranch style 1300 sq/ft home. A 1.5 acre lot. No hazards in the yard or home.
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?	Shawn Norem
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?	NA
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: