| Date & Referral Source | |||||||
| State: | {Applicant State:2} | Date of Application: | 06/05/2019 | 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 | Gender preferred: |
Female, Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Playful |
Other preferences: |
Okay in a setting with other dogs. I visit my parents house a lot and they have 2 dogs along with our dog milo (4 yr). They have a husky (5yr) and an australian shephard/ Catahoula mix (1 yr) | ||||||
| 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? |
Us!! We are a couple in Boone, Iowa looking for a puppy friend for our 4 year old red healer corgi mix from the Animal Rescue of Carroll. We do have my sisters cat currently living with us but she keeps to herself most of the time! | ||||||
Why do you want a Pembroke? |
We have some friends with corgis and they are the sweetest dogs I've ever met. Our dog milo is part corgi and we want him to have a friend! | ||||||
Activities planned with Pembroke: |
Go for walks, hikes, trips to my parents acreage, and our dog milo loves to play tug of war!! My parents dogs and milo have had many playdates with our friends corgis and were in love! | ||||||
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? |
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: |
Depends on the mistake. We have our penny bottle that we shake when our current dog is doing something wrong. I have house trained our current dog by knowing the body language when he needs to use the restroom and taking him outside quickly when you see him needing to. | ||||||
Discipline: |
We have a bottle of pennys that we shake when Milo is doing something he isn't supposed to. We learned it in a dog training book. | ||||||
Where would Pembroke spend the majority of the time: |
Either in our home or on my parents acreage. | ||||||
Discipline: |
We have a bottle of pennys that we shake when Milo is doing something he isn't supposed to. We learned it in a dog training book. Where would Pembroke spend the majority of the time: Either in our home or on my parents acreage. |
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|
House dog or outside dog? |
House dog | ||||||
People at home during the day? |
I leave in the morning and depending on the season will get home around 1. We also have Kirbys brother come to the house around 10 or 11 to let Milo out in the yard. | ||||||
Where would dog eat? |
In our home | ||||||
Where would dog sleep: |
In our bed | ||||||
Play & exercise: |
Daily, I take Milo on two walks along with weekend trips to my parents house. Every monday My parents' dog abby comes over for a play date because Mieko has to go to the vet every Monday (he tore his ACL) | ||||||
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? |
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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: |
|||||||
Landlord permission: |
|||||||
Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
|
Description of yard: |
We have a small yard with tall wooden fencing. We have a small shed in the corner of the yard along with a small brick fireplace in the middle. There are many plants growing on the outside of the yard and an awning with a table and chairs connected to the house. | ||||||
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? |
Ashley Ward and Kirby Johnson | ||||||
Willing to train children? |
Yes, We do not plan on having children in the next 5 years but if we do, we plan on teaching them to respect all 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? |
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? |
Yes, Milo had never met a cat before we brought my sister's into the home but we worked with him for a few weeks and kept them separated until they were ready to be together and now they are loving siblings. | ||||||
|
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} | ||||||