| Date & Referral Source | |||||||
| State: | Date of Application: | 02/12/2019 | 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: |
Any age | 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? |
Myself | ||||||
Why do you want a Pembroke? |
I recently put my two elderly Pembroke Welsh Corgi males to sleep as one was paralyzed with DM and the other had DM and cancer. One was a rescue and the other came from a breeder and I had them as a pair for over 10 years. I love their intelligence, silliness, loyalty and big heart in a small body. | ||||||
Activities planned with Pembroke: |
I took my two corgis everywhere. We traveled around the United States, we went to dog parks on a weekly basis when their health permitted, I specifically took them on a trip out to Oregon last fall as their "bucket list" trip so they could play in the ocean one last time. | ||||||
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: |
A firm voice that let's the dog know that I do not approve. With my last two corgis, this was all it took for them to know that what they did was not acceptable. I don't believe in raising my voice, just using a firm voice. I would also remove a dog from the situation if warrented. | ||||||
Discipline: |
Redirection, removing dog from situation if needed, letting them know through my voice and facial features that I do not approve. Assessing the situation to try and figure out why a dog is behaving in a certain way and how I can change the environment to change the behavior. | ||||||
Where would Pembroke spend the majority of the time: |
In the house. My last two corgis had free run of the house but I would create an environment that the dog felt safest and most comfortable in. This might mean gating off a part of the house if necessary or providing a large crate for the dog to freely get in and out of if that is what makes them most comfortable. | ||||||
Discipline: |
Redirection, removing dog from situation if needed, letting them know through my voice and facial features that I do not approve. Assessing the situation to try and figure out why a dog is behaving in a certain way and how I can change the environment to change the behavior. Where would Pembroke spend the majority of the time: In the house. My last two corgis had free run of the house but I would create an environment that the dog felt safest and most comfortable in. This might mean gating off a part of the house if necessary or providing a large crate for the dog to freely get in and out of if that is what makes them most comfortable. |
||||||
|
House dog or outside dog? |
House dog | ||||||
People at home during the day? |
No. I do come home for lunch though. | ||||||
Where would dog eat? |
In the kitchen | ||||||
Where would dog sleep: |
In a very cozy dog bed in the bedroom | ||||||
Play & exercise: |
There is a big back yard and I love taking pups to the dog park and on adventures. They would have an opportunity to exercise at least twice a day. | ||||||
How will you exercise your dog? |
Both on leash and restrained to the yard | ||||||
|
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? |
|||||||
Living arrangements: |
Rent/lease home | ||||||
Landlord info: |
|||||||
May we contact your landlord? |
Yes, you may 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? |
No | ||||||
|
Description of yard: |
I rent a home with an unfenced back yard that does not contain any swimming pools or hazards. This is the same house that I had my previous two corgis. My landlord does not object to dogs. | ||||||
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? |
Christina | ||||||
Willing to train children? |
I live alone | ||||||
|
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? |
I do not have pets currently | ||||||
|
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: |
|||||||