| Date & Referral Source | |||||||
| State: | {Applicant State:2} | Date of Application: | 03/25/2019 | Referred by: | Other | ||
| 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: |
Any age | Gender preferred: |
Either a Male or a Female | Color preferred: |
Red & White, Red Headed Tri, Black Headed Tri | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Energetic |
Other preferences: |
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| Dog Ownership History | |||||||
Previous dog owner? |
Yes | ||||||
Dog 1 |
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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? |
Orlyn and I are a couple who have been wanting a corgi for a long time, but our efforts to adopt or find any available ones have led nowhere. We both work as doctors, so our hours vary. However, our profession gives us a deeper understanding of prioritizing health, and our future corgi will be cared for appropriately and affectionately. We both are also very active, so he or she will certainly get those daily steps in. | ||||||
Why do you want a Pembroke? |
We love corgis for their size and energy. My husband and I are quite active, so we would love if our dog becomes a jogging partner (if weather permits). We are also shamelessly doting on dogs, and corgis in our experience enjoy the affection & belly rubs. Corgis are one of the friendlier breeds too; and ideally if his or her personality leans towards the calm side, we would like to train our corgi to be a pet therapy dog. That way, we can bring our corgi to work at the hospital and also share the love with patients and fellow doctors.
My close friend has a corgi, and when he was a puppy, I dogsat and helped raise him when the owner wasn’t available. My spouse and I have also attended dog shows where corgis and information about their breed are presented. We’ve done internet research and perused through corgi parent communities about the needs of this breed and raising them, but we’re also open to new information and advice from more experienced corgi owners. |
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Activities planned with Pembroke: |
Daily exercise most certainly. We live in a very dog friendly part of downtown Chicago and a block away from the lake. During the warm months, we would love to take him or her on runs along the lake.
Take him or her to corgi meet-ups near the city to interact with other dogs. If our dog doesn’t have any big health concerns, we would also take him on our travels to national parks or Corgi Beach Day type of events. Otherwise, our profession keeps us home mostly, so simply playing with and caring for him or her would work just as perfectly. |
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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: |
Say “no” in an even, firm, and affirmative voice. Redirect him or her or if necessary correct ir. | ||||||
Discipline: |
Depends on the offense. If he/she is nipping, then I would say “no” in an even tone and ignore until the nipping stops. If he/she is jumping on the couch without invitation, I would put him/her on the ground and say “no.” For excessive barking, I would first see what could be disturbing him/her and use a doggie timeout if necessary. Physical abuse to pets has never been tolerated in my household. | ||||||
Where would Pembroke spend the majority of the time: |
In our apartment | ||||||
Discipline: |
Depends on the offense. If he/she is nipping, then I would say “no” in an even tone and ignore until the nipping stops. If he/she is jumping on the couch without invitation, I would put him/her on the ground and say “no.” For excessive barking, I would first see what could be disturbing him/her and use a doggie timeout if necessary. Physical abuse to pets has never been tolerated in my household. Where would Pembroke spend the majority of the time: In our apartment |
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|
House dog or outside dog? |
House dog | ||||||
People at home during the day? |
No | ||||||
Where would dog eat? |
Kitchen | ||||||
Where would dog sleep: |
In his/her own bed in the living room | ||||||
Play & exercise: |
My husband and I exercise everyday, so we would take him or her to jog with us. We also have loved connecting with local corgi communities, so our dog would have plenty of opportunities to play with others as well. Our apartment complex is very dog friendly with a pet zone and regular dog happy-hours/socials. | ||||||
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: |
Apartment/condo complex | ||||||
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? |
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Lease allow dogs: |
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Landlord permission: |
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Restrictive covenants? |
No, the condo covenants do not prevent me from having a dog. | ||||||
Breed/size restrictions? |
Yes | ||||||
|
Description of yard: |
N/A | ||||||
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? |
Lina & Orlyn | ||||||
Willing to train children? |
We currently don’t have any children, but definitely will teach them how to humanely care for animals. | ||||||
|
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? |
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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, we will | ||||||
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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: |
{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} | ||||||