Untitled_2055 - Lakeshore Pembroke Welsh Corgi Rescue

Date & Referral Source
State:		Date of Application:	10/10/2018	Referred by:	Other
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:	Female	Color preferred:	Any color	Activity level:	Outgoing, Quiet, Playful, Energetic
Other preferences:	Needs to be a therapy dog so must be good with strangers, children, and other dogs. Also good with other animals as we have ducks and chickens.
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 to use as a therapy dog.
Why do you want a Pembroke?	I have had Pems for 25 years, both a male and female. Trained as therapy dog, obedience through Open, Rally, and Agility.
Activities planned with Pembroke:	Therapy dog. hiking, obedience.
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:	Through training.
Discipline:	"No" "Leave it" "chill" "quiet" with verbal and food rewards.
Where would Pembroke spend the majority of the time:	With me.
Discipline:	"No" "Leave it" "chill" "quiet" with verbal and food rewards. Where would Pembroke spend the majority of the time: With me.
House dog or outside dog?	House dog
People at home during the day?	Yes
Where would dog eat?	In the kitchen
Where would dog sleep:	In my bedroom.
Play & exercise:	Daily exercise playing on my 3 acres, hiking in forest preserve that I walk too and many others in the area, swimming, playing with neighbors/friends/family dogs and children,
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:	With famiy in my own apartment
Landlord info:
May we contact your landlord?
Lease allow dogs:
Landlord permission:
Restrictive covenants?	Not applicable
Breed/size restrictions?	No
Description of yard:	3 acres, barn, chicken coops, creek, round pen, above ground pool, creek, horses next door.
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?	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
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: