Untitled_2162 - Lakeshore Pembroke Welsh Corgi Rescue

Date & Referral Source
State:		Date of Application:	12/26/2018	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, 3 years – 5 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:
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?	The pet is for myself.
Why do you want a Pembroke?	After doing research for over a year now, my Dr and I believe a corgi would be the best fit for me. The size, general mannerisms and loyalty were the main positives that brought us to this decision.
Activities planned with Pembroke:	I would play with toys indoors, go to the lake and on the pontoon, walks along our woods, campfires in the summer out back, and a large yard to play.
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?	No
Vet contact info:
Will handle mistakes Pembroke makes like this:	With stern voice, and time outs from toys.
Discipline:	A stern voice and time outs, so to speak, just like a child. Odor blockers for accidents and crate training.
Where would Pembroke spend the majority of the time:	He/she will ALWAYS be with me… Vacations, parties, drives.. Always with me!
Discipline:	A stern voice and time outs, so to speak, just like a child. Odor blockers for accidents and crate training. Where would Pembroke spend the majority of the time: He/she will ALWAYS be with me… Vacations, parties, drives.. Always with me!
House dog or outside dog?	House dog
People at home during the day?	Always!
Where would dog eat?	In the dining room next to the table 3 times a day, every time I eat. Plus snacks😊
Where would dog sleep:	With me if it wants to, but I am also getting an aspca crate and bed. So it can sleep where it wants.
Play & exercise:	Every day we will play. At least 3 short walks a day with me, and a very large yard for him to play.
How will you exercise your dog?	Both on leash and 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?	I have a privacy 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:	I have a large yard with privacy fence. A campfire pit in the back with picnic table and chairs.
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?	Billie Brummels
Willing to train children?	I had a hysterectomy in 2010 and all of my children are grown. All of my grandchildren have dogs and have been around them since birth.
Any allergies?	No one is allergic.
Current pets:
Current pets dog friendly?
Are you willing to work on it if your new dog doesn’t get along with your current pets right away?	No pets now… I do not want more than 1
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: