| Date & Referral Source | |||||||
| State: | Date of Application: | 11/13/2018 | 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: |
3 years – 5 years, 5 years – 10 years, 10 years + | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Quiet, Playful, Other (Please describe in the box below.) |
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? |
Myself | ||||||
Why do you want a Pembroke? |
I am looking to adopt a Corgi because I am looking for a small short dog. What I like about this breed is that they are smart and assertive. They are a big dog in a small dog's body. I do not have experience with Corgis but have owned two Swedish Vallhunds so I understand the herding dog personality. I have done research on this breed and know they shed, can bark a lot, and have a tendency to become overweight. | ||||||
Activities planned with Pembroke: |
The activities I would do is go for walks, play ball or Frisbee, take day trips to the beach, visit family, and just plain hang out together. | ||||||
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: |
If I catch them in the act I will immediately say outside and take them outside to finish their job, otherwise I will just clean up the mess but still take the dog outside. | ||||||
Discipline: |
I don't really use discipline but rather positive reinforcement by rewarding with treats. | ||||||
Where would Pembroke spend the majority of the time: |
Most of their time would be spent with me in or outside of my home. | ||||||
Discipline: |
I don't really use discipline but rather positive reinforcement by rewarding with treats. Where would Pembroke spend the majority of the time: Most of their time would be spent with me in or outside of my home. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
No one is home except me when I'm not at work. | ||||||
Where would dog eat? |
They would have a space designated in the kitchen, | ||||||
Where would dog sleep: |
More than likely in my bedroom with me. | ||||||
Play & exercise: |
My Corgi will have play time and exercise with me after work and on days off. Also, there will be plenty of playtime with my grandson. I live very close to a bike/walking trail so there will be daily walks, weather permitting. | ||||||
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: |
Rent/lease home | ||||||
Landlord info: |
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May we contact your landlord? |
No, you may not contact my landlord. | ||||||
Lease allow dogs: |
Yes, my lease permits dogs. | ||||||
Landlord permission: |
Yes, my landlord is fine with me owning a Pembroke | ||||||
Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
Yes | ||||||
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Description of yard: |
I live in a mobile home park. I have a fairly large yard that currently does not have a fence, but will put one in if I get a dog. | ||||||
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? |
Gail Ansersom | ||||||
Willing to train children? |
Definately | ||||||
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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? |
.n/a | ||||||
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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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