Untitled_2017 - Lakeshore Pembroke Welsh Corgi Rescue

Date & Referral Source
State:		Date of Application:	09/11/2018	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, 5 years – 10 years	Gender preferred:	Either a Male or a Female	Color preferred:	Any color	Activity level:	Couch Potato, Outgoing, Quiet, Playful, Other (Please describe in the box below.)
Other preferences:	Some physical such as hearing issues (I wear hearing aids), vision (I have a strong eye prescription), a missing limb. Also separation issues I don’t see as a problem since I spend most of my time at home and usually only go out to the the grocery or the doctor’s appt. I do on occasion end up in the hospital but when that happens my daughter takes Roarke to her house so he is never totally alone, although he doesn’t have a problem with being alone for some periods of time.
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?	Myself. I became disabled about 3 yrs ago and for the most time stay at home. I have a fantastic 12yr Old Pembroke named Roarke who is my constant companion. Last yr he had a major health issue where I almost lost him and realized I wanted to add to my “family” before that happened. I am not able to go through the wonderful puppy time and am looking for a adult that has matured a little. A adult with separation issues wouldn’t be a problem for me or even physical issues such as hearing, some vision issues or a missing limb. I’m not perfect either. Please keep me in mind as a forever home for a wonderful Pembroke. I am more than willing to travel to be considered as a new parent. I have a wonderful support system should that is more than ready & willing to help me love another. Roarke goes to “sleep” overs at sissies house where he is bathed, fluffed, spoiled and fed his special treats fresh green beans.
Why do you want a Pembroke?	I adore my Roarke a Pembroke. I so enjoy their positive attitude, he always make me smile all through the day. Their intelligence and somewhat stubborn attitude on occasion. Having lived with Roarke for over 12 years we have pretty much experienced just about every situation a couple can, Been mad at each other and got over it, shared joy, loss, frustration, you name it. His sister has lived with me frequently over these 12 yrs since my son was in the Navy and not always able to take her with him overseas. Yes I have done frequent research over the years because the breed just fascinates me
Activities planned with Pembroke:	I’m not able to walk far but I have a fenced in yard and enjoy going out in the yard with him or we go out on my front porch so he can inform the neighbors he is in charge and requires loving. I travel to Baltimore several times a year. Bursts of sudden energy are fine but not constant or hyper
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:	Say term letting them know not acceptable then distract them to something I can praise them for
Discipline:	Voice, clicker, sound device, what works for that particular not not all of mine have responded to the same thing
Where would Pembroke spend the majority of the time:	With me in my house
Discipline:	Voice, clicker, sound device, what works for that particular not not all of mine have responded to the same thing Where would Pembroke spend the majority of the time: With me in my house
House dog or outside dog?	House dog
People at home during the day?	Yes me pretty much always
Where would dog eat?	In my kitchen
Where would dog sleep:	In a kennel in my bedroom
Play & exercise:	I have friends with dogs who do play dates and my daughter takes Roarke on occasion to a 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?	Both sides are 8ft wooden, the back is chain link and there is a gate across the drive that is going to be remote controlled
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:	Small front yard decorative but used. Long side drive back to garages then fairly large grassed lawn
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?	Debra Womack
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?	Yes! Giving up is only a final resort. The puppy I Had adopted I only gave up once it became clear Iwas not a good fit for him or he for me when he twice pulled me off my feet and caused me to fall. He was just toohyperactive and needed a family with plenty of energy to help him use that in a positive way. I can’t move quickly and the playing I can’t give him a good release of energy to help deal with it. I was told he was corgi, dachshund but believe he was possible fox terrier with hyper energy.
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: