| Date & Referral Source | |||||||
| State: | Date of Application: | 05/02/2018 | 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: |
0 months – 1 year (we rarely get dogs in this age group), 1 year – 3 years | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Outgoing, Quiet, Playful |
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? |
WE HAVE AN EXPERIENCE FOR ADOPTING A CORGI 5 YEARS AGO. RECENTLY MY MOM LOST HER DOG AND WE DECIDED TO HAVE A NEW FAMILY. |
||||||
Why do you want a Pembroke? |
WE HAD RESCUED A CORGI 5 YEARS AGO FROM THE SHELTER. I HEARD THAT SHE HAD TO SENT TO THE SHELTER BECAUSE HER MOTHER HAD TO GO TO THE NURSING HOME. SHE WAS 9 YEARS OLD WHEN WE ADOPT HER. WE ALWAYS LOVE HER THE BEST.. SADLY, SHE DIED LAST MONTH. WE MISSED HER SO MUCH AND DECIDED TO ADOPT A NEW FAMILY. |
||||||
Activities planned with Pembroke: |
We like to go to the dog park. Since my mom has two nail salon, she used to take her dog to the shop every day. |
||||||
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: |
We will train him/her as we learned from the class. | ||||||
Discipline: |
I know I'm spoiling my dogs with loves.. | ||||||
Where would Pembroke spend the majority of the time: |
At mom's home, at mom's nail salon. | ||||||
Discipline: |
I know I'm spoiling my dogs with loves.. Where would Pembroke spend the majority of the time: At mom's home, at mom's nail salon. |
||||||
|
House dog or outside dog? |
House dog | ||||||
People at home during the day? |
yes. | ||||||
Where would dog eat? |
At home. | ||||||
Where would dog sleep: |
At home. on the bed. | ||||||
Play & exercise: |
We take our dog to the dog park every weekend and also we love to go walk with dogs. | ||||||
How will you exercise your dog? |
On leash | ||||||
|
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: |
no swimming pool and no deck. We have a nice beautiful yard. |
||||||
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? |
BECKY | ||||||
Willing to train children? |
YES | ||||||
|
Any allergies? |
No one is allergic. | ||||||
Current pets: |
|||||||
|
Current pets dog friendly? |
|||||||
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: |
|||||||