| Date & Referral Source | |||||||
| State: | Date of Application: | 09/28/2018 | Referred by: | Friend | |||
| 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: |
Red & White, Red Headed Tri, Black Headed Tri, Sable & White | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Energetic, Very Active |
Other preferences: |
There are no pets in the home currently and I have a large backyard. | ||||||
| Dog Ownership History | |||||||
Previous dog owner? |
No | ||||||
Dog 1 |
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Dog 1 name: |
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Dog description: |
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Where is this dog now? |
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| Dog 2 | |||||||
Dog 2 name: |
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Dog description: |
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How long owned? |
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Where is the dog now? |
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| Dog 3 | |||||||
Dog 3 name: |
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Dog description: |
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How long owned? |
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Where is dog now? |
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| Dog 4 | |||||||
Dog 4 name: |
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Dog description: |
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How long owned? |
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| Where is this dog now? | |||||||
| Questions Regarding Motivation for Adopting and Intentions | |||||||
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Who is this dog for? |
This Pembroke is for myself. I am looking to adopt a healthy corgi in the Illinois/Wisconsin area. | ||||||
Why do you want a Pembroke? |
I want to adopt a Pembroke Welsh Corgi because I love the breed. I am looking for an fairly active and beautiful breed that can match my lifestyle. I have spent the past year dog sitting a corgi mix and I am excited to have one of my own. I have been researching smaller breed that also have healthy records which is where I came across this organization as a way for me to adopt a corgi in need of a loving home. | ||||||
Activities planned with Pembroke: |
I would take my Pembroke on my daily walks, typically under a mile. I also would take my Pembroke along with my on my weekend trips exploring neighborhoods in Chicago and spending time outside. | ||||||
Aware that Pembrokes are busy, noisy dogs? |
Yes | ||||||
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Money for basic care? |
Yes | ||||||
Money for unforeseen medical expenses? |
Yes | ||||||
Willing to house train? |
Yes Willing to do formal training? Yes |
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Do you have a veterinarian? |
No | ||||||
Vet contact info: |
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Will handle mistakes Pembroke makes like this: |
Using positive reinforcement (treats) I will reward the good behavior and pay no attention when the dog makes a mistake or needs to change the behavior. | ||||||
Discipline: |
Positive reinforcement such as treats and if the behavior is out of hand then the dog will be put into their crate for a limited time so they are able to calm down. | ||||||
Where would Pembroke spend the majority of the time: |
Mostly out and about in the house but my home is to train the Pembroke to sleep in a dog bed I will place within their crate. | ||||||
Discipline: |
Positive reinforcement such as treats and if the behavior is out of hand then the dog will be put into their crate for a limited time so they are able to calm down. Where would Pembroke spend the majority of the time: Mostly out and about in the house but my home is to train the Pembroke to sleep in a dog bed I will place within their crate. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes. one person works from home in the house where the Pembroke will stay. | ||||||
Where would dog eat? |
In the kitchen. | ||||||
Where would dog sleep: |
Hopefully in their dog bed in their crate during training but after they are more suited to the home they will sleep on the first floor of the house or in my bedroom in their bed on the floor. | ||||||
Play & exercise: |
There are a few dog meet up groups in my town in addition to well trained (show) dogs on my street. The corgi will get at least 1 hour of formal outdoor exercise during the week and up to 4 hours during the weekend. | ||||||
How will you exercise your dog? |
Both on leash and restrained to the yard | ||||||
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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? |
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Living arrangements: |
Own home | ||||||
Landlord info: |
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May we contact your landlord? |
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Lease allow dogs: |
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Landlord permission: |
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Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
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Description of yard: |
My backyard consists of a tree house, grassy area, and 2 car garage. All sides of my yard is surrounded by fences so an enclosed fence should not be difficult to complete. | ||||||
Household members: |
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Everyone in household agrees about adopting a corgi? |
Yes, everyone agrees and wants to adopt a Pembroke Welsh Corgi. | ||||||
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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? |
Katrine Weismantle | ||||||
Willing to train children? |
yes, but there are no children in the home currently | ||||||
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Any allergies? |
No one is allergic. | ||||||
Current pets: |
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Current pets dog friendly? |
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Are you willing to work on it if your new dog doesn’t get along with your current pets right away? |
yes, although i have no pets in the home currently | ||||||
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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. | ||||||
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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: |
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