Untitled_2329

Applicant IL
State: {Applicant State:2} Date of Application: 04/07/2019 Referred by: Website
First name: {First Name:98} Last name: {Last Name:97} First name 2: {First Name 2:94} Last name 2: {Last Name 2:93}
Street: {Street Address:3}
City: {City:4} State: {State:5} Zip: {Zip:6}

Ages interested in:
 1 year – 3 years, 3 years – 5 years
Gender preferred:
 Either a Male or a Female
Color preferred:
 Any color
Activity level:
 Couch Potato, Outgoing, Playful, Other (Please describe in the box below.)

Other preferences:
 Own a 1 year old female spayed who likes other dogs and would enjoy a playmate

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}

Who is this dog for?

 Larry Jordan

Why do you want a Pembroke?
 This would be the third Pembroke to live here. My last dog was. Male Pembroke named Norman who died in his sleep at the age of 15. We also had a Collie at the same time who passed when he was 13. Wanted a dog smaller than the Collie this time.

Activities planned with Pembroke:
 Play in the house, in the yard and walks

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:
 {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: 		A firm No!, or a Hey! To get his attention. Then redirect him to a positive activity,

Discipline:
 My current pup Ellie sometimes gets “bratty” where she nips my feet or shoes to get my attention. I will separate her like put her in the yard for 20 minutes and ignore her. She doesn’t like to ignored, and stops the behavior.

Where would Pembroke spend the majority of the time:
 In the house

Discipline:
 My current pup Ellie sometimes gets “bratty” where she nips my feet or shoes to get my attention. I will separate her like put her in the yard for 20 minutes and ignore her. She doesn’t like to ignored, and stops the behavior.
Where would Pembroke spend the majority of the time: In the house

House dog or outside dog?

 House dog

People at home during the day?
 Yes

Where would dog eat?
 Dining room area on a mat with his own food dish

Where would dog sleep:
 Floor, crate or on bed, whichever he prefers

Play & exercise:
 Chew toys, balls and squeak toys in a dog toy box in the living room, and romping in the yard with Ellie. Daily walk

How will you exercise your dog?
 Both on leash and restrained to the yard

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 all around the yard

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?

Lease allow dogs:

Landlord permission:

Restrictive covenants?
 Not applicable

Breed/size restrictions?
 No

Description of yard:

 Deck out the back door, lawn, lots of trees and shrubby areas, plenty of shade. No 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?
 Larry Jordan

Willing to train children?
 No children

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?
 It would be required that Ellie and the adopted dog get along

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}