| Date & Referral Source | |||||||
| State: | Date of Application: | 01/10/2019 | 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: |
1 year – 3 years, 3 years – 5 years | Gender preferred: |
Male | Color preferred: |
Any color | Activity level: |
Outgoing, Quiet, Playful |
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 and my current PWC, Abby. I adopted her through your organization in 2009. | ||||||
Why do you want a Pembroke? |
I got my first Corgi, Mick, in 2002 at 8 weeks old from a breeder because I, yes, had always loved the breed. Mick and I did agility, canine good citizen, and other general training, kayaked together for most of his life, played fetch every day, and generally had a great time. When he was seven, I adopted Abby from your organization so he would have a companion. They were a great pair until his death this past summer. Abby has adapted well to being a single dog, but I think she would benefit from having a buddy again. | ||||||
Activities planned with Pembroke: |
I would hope to take any dog on the water, as I do with Abby, go for walks, play fetch, and hang out. | ||||||
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: |
Most mistakes are just that mistakes, doing something they don't know yet is wrong, or generally not the end of the world. A firm "no" may be appropriate but that's pretty much all I've ever needed with either Abby or Mick. | ||||||
Discipline: |
I've taught both of my Corgi the usual commands (e.g., come, sit, off, no, leave it, etc.) through positive reinforcement and repetition. | ||||||
Where would Pembroke spend the majority of the time: |
I am at work during the day and Abby is at home. When I'm home, she's hanging out with me or sometimes snoozing in her own house. | ||||||
Discipline: |
I've taught both of my Corgi the usual commands (e.g., come, sit, off, no, leave it, etc.) through positive reinforcement and repetition. Where would Pembroke spend the majority of the time: I am at work during the day and Abby is at home. When I'm home, she's hanging out with me or sometimes snoozing in her own house. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
No. I occasionally use a dog-walking service, but not routinely. | ||||||
Where would dog eat? |
In the kitchen, where Abby eats. | ||||||
Where would dog sleep: |
Abby has her own house (a dog crate with no door) and she sleeps there and on my bed, as did my other Corgi. I would have another house for the new Corgi. | ||||||
Play & exercise: |
A new Corgi would get daily exercise on walks with me and Abby, as well as play in the yard. If the new one is a fetcher, we'll go to the local park or wherever there's a lot of space to run. It all depends on what the new dog might prefer (e.g., Abby is not the least bit interested in fetch). | ||||||
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 on two sides, privacy fence on the other two sides. | ||||||
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: |
Typical suburban back yard, about 20×40, grass, shrubs and small trees around the perimeter. | ||||||
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? |
Barbara ` Pamp | ||||||
Willing to train children? |
N/A | ||||||
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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? |
Yes. | ||||||
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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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