| Date & Referral Source | |||||||
| State: | {Applicant State:2} | Date of Application: | 03/22/2019 | Referred by: | Website | ||
| Contact Information | |||||||
| First name: | {First Name:98} | Last name: | {Last Name:97} | First name 2: | {First Name 2:94} | Last name 2: | {Last Name 2:93} |
| Address | |||||||
| Street: | {Street Address:3} | ||||||
| City: | {City:4} | State: | {State:5} | Zip: | {Zip:6} | ||
| 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, 5 years – 10 years | Gender preferred: |
Either a Male or a Female | Color preferred: |
Red & White, Red Headed Tri, Black Headed Tri, Sable & White, Any color | Activity level: |
Outgoing, Quiet, Playful, Energetic, Very Active, Other (Please describe in the box below.) |
Other preferences: |
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| Dog Ownership History | |||||||
Previous dog owner? |
Yes | ||||||
Dog 1 |
|||||||
Dog 1 name: |
{Dog Name (Most recent/ current first):24} | ||||||
Dog description: |
{Description of Dog:25} | ||||||
How long owned? |
{Length of time owned:26} | ||||||
Where is this dog now? |
{Where is this dog now? (Explain if you no longer have the dog):37} | ||||||
| Dog 2 | |||||||
Dog 2 name: |
{Dog Name (Most recent/ current first):30} | ||||||
Dog description: |
{Description of Dog:33} | ||||||
How long owned? |
{Length of time owned:35} | ||||||
Where is the dog now? |
{Where is this dog now? (Explain if you no longer have the dog):39} | ||||||
| Dog 3 | |||||||
Dog 3 name: |
{Dog Name (Most recent/ current first):29} | ||||||
Dog description: |
{Description of Dog:32} | ||||||
How long owned? |
{Length of time owned:36} | ||||||
Where is dog now? |
{Where is this dog now? (Explain if you no longer have the dog):27} | ||||||
| Dog 4 | |||||||
Dog 4 name: |
{Dog Name (Most recent/ current first):28} | ||||||
Dog description: |
{Description of Dog:31} | ||||||
How long owned? |
{Length of time owned:34} | ||||||
| Where is this dog now? | {Where is this dog now? (Explain if you no longer have the dog):38} | ||||||
| Questions Regarding Motivation for Adopting and Intentions | |||||||
|
Who is this dog for? |
The Pembroke would be for myself. I have loved dogs and have always had a special affinity for corgis. | ||||||
Why do you want a Pembroke? |
I first fell in love with corgis when I saw pictures of them on Pinterest and fell in love with their stature and fluffy butts. After I learned about the mythology that surrounds the breed in the UK I loved them ever since even more. I also love how they’re friendly and outgoing dogs. | ||||||
Activities planned with Pembroke: |
I would like to take them outdoors for hiking excuresions, play at the park, explore the city, walking to place to have brunch and sit outside. | ||||||
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 |
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|
Do you have a veterinarian? |
No | ||||||
Vet contact info: |
{If yes, please provide contact information including the vet’s name, clinic name, street address, city, state, zip, and phone. Also include the website if there is one.:52} | ||||||
Will handle mistakes Pembroke makes like this: |
I would first redirect the dog if they’re still making the mistake to draw their attention away from the item. Then I would give them something else that they’re allowed them to have. | ||||||
Discipline: |
Positive obedience training | ||||||
Where would Pembroke spend the majority of the time: |
They would be inside during the time I am at work but during the evenings and mornings they would be walked. On the weekends we would go to the park or other places to exercise. | ||||||
Discipline: |
Positive obedience training Where would Pembroke spend the majority of the time: They would be inside during the time I am at work but during the evenings and mornings they would be walked. On the weekends we would go to the park or other places to exercise. |
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|
House dog or outside dog? |
House dog | ||||||
People at home during the day? |
There aren’t during the school year but my work is 10 minutes away and I am allowed to leave and could come home in the middle of the day if needed. | ||||||
Where would dog eat? |
They would eat in the kitchen. | ||||||
Where would dog sleep: |
They would have a bed in my bedroom or living room. | ||||||
Play & exercise: |
Walk or run in the morning and a walk as soon as I got home from work. Take them to the dog park to run around. | ||||||
How will you exercise your dog? |
On leash | ||||||
|
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: |
{If you rent/lease your home, please list the name, telephone number and email address of your landlord. State “Not Applicable” if you own your own home.:67} | ||||||
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? |
Yes | ||||||
|
Description of yard: |
Not applicable. | ||||||
Household members: |
{Describe all the people who live in your home, include names, ages and interests. For example, Mary Smith, 29, Enjoys cooking, dog training, gardening and running.:75} | ||||||
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? |
Myself | ||||||
Willing to train children? |
I don’t have children but if I did I would. | ||||||
|
Any allergies? |
No one is allergic. | ||||||
Current pets: |
{Please list and describe all of the pets that currently live in your home, including the name, type, age, sex and whether it is neutered. For example, Lenny, komodo dragon, 3 years old, not neutered.:80} | ||||||
|
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? |
N/A | ||||||
|
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: |
{Personal References. Please list two people who know your family well, but who are not related to you (No moms, grandmas, sisters, etc) who will attest to the fact that you are a responsible, dedicated pet owner. Include the name of the person, their phone number(s), email and relationship you have with that person. For example, Mary Smith, 123-343-4444, 123-333-5767, marys@gmail.com, friend.:87} | ||||||