Untitled_1744 - Lakeshore Pembroke Welsh Corgi Rescue

Date & Referral Source
State:		Date of Application:	04/01/2018	Referred by:	Veterinarian
Contact Information
First name:		Last name:		First name 2:		Last name 2:
Address
Street:
City:			State:		Zip:
Type of Dog Wanted
Ages interested in:	0 months – 1 year (we rarely get dogs in this age group), 1 year – 3 years, 3 years – 5 years, 5 years – 10 years	Gender preferred:	Either a Male or a Female	Color preferred:	Any color	Activity level:	Couch Potato, Outgoing, Quiet, Playful, Energetic, Very Active
Other preferences:	Since I do have one (very gentle, passive) dog, I would avoid adopting an overly-aggressive or territorial puppy/dog.
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?	Me.
Why do you want a Pembroke?	I have researched the breed and love the playfulness of their personalities.
Activities planned with Pembroke:	I have the ideal location for dog-ownership…safe walking paths that circle the lake are right across the street. Also a nearby dog park. My home is dog proof so even a Great Dane can safely zoon when the urge strikes. I'm retired so I'm home at all times or take my dog with me when I do travel.
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:	Depends on the 'mistake' – redirection, repetition, positive reinforcement (treats)
Discipline:	Positive reinforcement (treats)
Where would Pembroke spend the majority of the time:	Roaming the house — although a safe, cozy place (kennel) would be provided so he/she could choose to chill out in their condo.
Discipline:	Positive reinforcement (treats) Where would Pembroke spend the majority of the time: Roaming the house — although a safe, cozy place (kennel) would be provided so he/she could choose to chill out in their condo.
House dog or outside dog?	House dog
People at home during the day?	Yes – all the time
Where would dog eat?	Home – kitchen area
Where would dog sleep:	His/her choice – bed, couch, kennel
Play & exercise:	Play/exercise is part of the daily routine
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:	Log house with large yard. My current pup, Maisy Moose, is always on a gentle leader or tie-out when we go outside — even to walk to the car.
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?	Me
Willing to train children?	Not applicable but all relatives are dog lovers/owners that treat pets as family members.
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: