Untitled_1820 - Lakeshore Pembroke Welsh Corgi Rescue

Date & Referral Source
State:		Date of Application:	05/10/2018	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, 3 years – 5 years, 5 years – 10 years, 10 years +, Any age	Gender preferred:	Male, Female, Either a Male or a Female	Color preferred:	Red & White, Red Headed Tri, Black Headed Tri, Sable & White, Any color	Activity level:	Couch Potato, Outgoing, Quiet, Playful, Energetic, Very Active
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?	Me and my wife also looking for Corgi/Shepherd mix
Why do you want a Pembroke?	My wife and I had a Corgi/Shepherd for the big 12 years he was he like our child and we loved him much and he had much personality and he was cream white color.
Activities planned with Pembroke:	Walking to the beach everyday or doggie park and car rides
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:	Give the doggie a big hug
Discipline:	A little but not much I would spoil the dog
Where would Pembroke spend the majority of the time:	Walking and playing or sleeping on king size bed
Discipline:	A little but not much I would spoil the dog Where would Pembroke spend the majority of the time: Walking and playing or sleeping on king size bed
House dog or outside dog?	House dog
People at home during the day?	Yes my wife
Where would dog eat?	In my house in the kitchen
Where would dog sleep:	In my king size bed
Play & exercise:	Very exercise provide the dog with big back yard to play and trips to dog park
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?	It's 6 ft high wood fence and gives much privcy
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:	It's a back yard with a fence and a big tree in the middle where a squirrel comes everyday
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?	Todd Pawlaczyk and Alice Pawlaczyk
Willing to train children?	No children sorry
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: