Untitled_2129 - Lakeshore Pembroke Welsh Corgi Rescue

Date & Referral Source
State:		Date of Application:	12/03/2018	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:	0 months – 1 year (we rarely get dogs in this age group), 1 year – 3 years, 3 years – 5 years	Gender preferred:	Either a Male or a Female	Color preferred:	Any color	Activity level:	Couch Potato, Outgoing, Quiet, Playful
Other preferences:
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?	My family.
Why do you want a Pembroke?	My daughter, who is 13, fell in love with Corgis a few years ago. We have a few in our town that we see on a regular basis. They are loving, fun, adorable dogs and the perfect size for our family. We love their playfulness and desire to be part of our family.
Activities planned with Pembroke:	We are very active, so we would take him/her on walks, swimming, playing fetch in the yard (which is fenced in), and we have a dog park that he/she would love etc.
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:	correction and positive reinforcement
Discipline:	always positive reinforcement. We use repetitive commands and treat rewards.
Where would Pembroke spend the majority of the time:	At our home. My husband is home during the day and me and the kids are home at night. We have a mixed schedule.
Discipline:	always positive reinforcement. We use repetitive commands and treat rewards. Where would Pembroke spend the majority of the time: At our home. My husband is home during the day and me and the kids are home at night. We have a mixed schedule.
House dog or outside dog?	House dog
People at home during the day?	Yes
Where would dog eat?	We have all the food and water in our laundry room.
Where would dog sleep:	In our bedroom on a comfy rug.
Play & exercise:	Walks, playing in the back yard. Daily.
How will you exercise your dog?	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?	It is a white, 5-foot high (approx.) picket fence.
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:	We have a large fenced in yard. There is a fire pit and some gardens and trees.
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?	Simone Kozminski
Willing to train children?	Yes, of course!
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: