| Date & Referral Source | |||||||
| State: | {Applicant State:2} | Date of Application: | 03/27/2019 | 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: |
Any age | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Outgoing, Quiet |
Other preferences: |
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| Dog Ownership History | |||||||
Previous dog owner? |
No | ||||||
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? |
The Pembroke is for our family. I have two daughters, ages 15 & 13. | ||||||
Why do you want a Pembroke? |
My daughters and I love the breed and we've done extensive research. We love that Corgis are intelligent and like to snuggle. | ||||||
Activities planned with Pembroke: |
We have a fenced-in backyard and look forward to throwing tennis balls for the Corgi to chase. We also live on a court so the dog won't be exposed to a lot of traffic. We will take the dogs for walks before school and after school. I will hire a dog walker to take him/her out during the day and play for a while. | ||||||
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 use positive reinforcement training including praise, play and food rewards. | ||||||
Discipline: |
I would immediately correct the corgi's behavior so he/she knows what isn't appropriate and what is acceptable. | ||||||
Where would Pembroke spend the majority of the time: |
The corgi would spend most of his/her time in the house during the school year but will have ample opportunities to play outside before and after school, on the weekends and in the summer. | ||||||
Discipline: |
I would immediately correct the corgi's behavior so he/she knows what isn't appropriate and what is acceptable. Where would Pembroke spend the majority of the time: The corgi would spend most of his/her time in the house during the school year but will have ample opportunities to play outside before and after school, on the weekends and in the summer. |
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|
House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Unfortunately, there are no people home during the day at our house. We work outside of the home and my daughters go to school — Jr. High and High School. | ||||||
Where would dog eat? |
The corgi would have a special place to eat in the kitchen or the laundry room. | ||||||
Where would dog sleep: |
The corgi would sleep with the girls or with me. | ||||||
Play & exercise: |
We will take him/her for walks before and after school and will play with him/her after school and on the weekends — more so in the summer months. | ||||||
How will you exercise your dog? |
On leash | ||||||
|
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? |
Our fence is wooden and is a little over 6ft tall from the ground to the top of the fence. | ||||||
Living arrangements: |
Own 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? |
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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 | ||||||
|
Description of yard: |
We have a large back yard that can accommodate a volleyball court. We do not have a pool. | ||||||
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? |
Anne-Marie Cronin | ||||||
Willing to train children? |
I grew up with dogs and my daughters have spent a lot of time around my parents' cocker spaniel and treat it very well. They are good with dogs. | ||||||
|
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? |
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} | ||||||