| Date & Referral Source | |||||||
| State: | Date of Application: | 11/08/2018 | 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 | Gender preferred: |
Female | Color preferred: |
Red & White, Red Headed Tri, Sable & White | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Energetic |
Other preferences: |
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| Dog Ownership History | |||||||
Previous dog owner? |
Yes | ||||||
Dog 1 |
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Dog 1 name: |
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Dog description: |
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How long owned? |
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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? |
Me (45) and my family (2 girls, ages 6.5 and 10.5) | ||||||
Why do you want a Pembroke? |
We owned a corgi mix that lived to be 17 (along with other mixed breeds that lived to be 13-15). I love that corgis have big personalities despite their small-medium size. They are brave and a little pushy but are also very sweet, goofy, and playful. I also love to see them run—their little legs can really keep up! | ||||||
Activities planned with Pembroke: |
Cuddle, go on walks, go to dog parks, go hiking, play ball in the backyard, do running tricks or fun drills/“jobs” in the backyard. | ||||||
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? |
Yes | ||||||
Vet contact info: |
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Will handle mistakes Pembroke makes like this: |
– Verbal command (no, off, etc.) – Show them the right way (take them off the furniture, take them outside, etc.) – Praise them for the correct behavior |
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Discipline: |
– First try to prevent the issue, distraction, etc. – Firm verbal feedback (no, off) – Praise (positive/happy voice) – Reward (affection, treat) |
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Where would Pembroke spend the majority of the time: |
At home inside (during the day, 4 days/week), outside for walks or playing with the kids in the evenings and I’m weekends. I also work from home 1 day/week, so I’d be home with her (inside, in the backyard on my laptop, and we can go on an extra walk on that day). | ||||||
Discipline: |
– First try to prevent the issue, distraction, etc. – Firm verbal feedback (no, off) – Praise (positive/happy voice) – Reward (affection, treat) Where would Pembroke spend the majority of the time: At home inside (during the day, 4 days/week), outside for walks or playing with the kids in the evenings and I’m weekends. I also work from home 1 day/week, so I’d be home with her (inside, in the backyard on my laptop, and we can go on an extra walk on that day). |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
1 day each weekday, yes. Also yes on the weekends. We keep most weekends low key. | ||||||
Where would dog eat? |
It depends what she’s been eating beforehand in the beginning at least. We haven’t had a dog in a couple of years, but the foods we fed past dogs include homemade dog food (meat plus kale or green beans), Evo, Natura, and Blue Buffalo. Different dogs of ours had different diets, and one had to have a novel protein so I ended up making her food. | ||||||
Where would dog sleep: |
On a dog bed or in a crate | ||||||
Play & exercise: |
She can play every night with my kids in the yard (ball, running, jumping). Also, we’ll take her on daily walks, and I can give her an extra walk on my work-from-home day. On weekends there’s even more time for play in the yard or at the forest preserve or dog park. | ||||||
How will you exercise your dog? |
Both on leash and restrained to the yard | ||||||
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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? |
Chain link, 4’ high. It is currently open on one side for about 20’. We just bought the home in the summer and will be finishing off the fence line. | ||||||
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: |
Small patio, raised deck, signicant grass (most of the yard), large bushes on the perimeter, garage on one side—no pool. | ||||||
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? |
Wendy Zachrisen | ||||||
Willing to train children? |
Yes, and my kids have had quite a bit of dog experience. We’ve owned 3 dogs (all deceased now due to old age) since my kids were born. They also have a dog at their dad’s house, their grandparents have a dog, and my best friend (like their aunt) has 3 dogs (including a herding breed) and is involved in a rescue. We frequently spend time with her dogs and foster dogs. | ||||||
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Any allergies? |
No one is allergic. | ||||||
Current pets: |
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Current pets dog friendly? |
No, some of our current pets are not friendly toward dogs | ||||||
Are you willing to work on it if your new dog doesn’t get along with your current pets right away? |
If the hamster panics at the fact that there’s a dog in the house, he can be confined to a specific room with a secured/closed door. | ||||||
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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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