Untitled_2451 - Lakeshore Pembroke Welsh Corgi Rescue

Date & Referral Source
State:	{Applicant State:2}	Date of Application:	06/27/2019	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:	0 months – 1 year (we rarely get dogs in this age group), 1 year – 3 years	Gender preferred:	Either a Male or a Female	Color preferred:	Red & White, Red Headed Tri	Activity level:	Couch Potato, Outgoing, Quiet, Playful, Energetic
Other preferences:
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?	My Family
Why do you want a Pembroke?	I love the corgi breed. A friend of mine has corgis, I love how smart and funny they are. Such personalities! We had a larger dog in the past and are looking to rescue a medium size dog.
Activities planned with Pembroke:	Walking, camping, boating…..I have 3 little girls that will give the little fluff butt all the love he/she fans handle.
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?	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:	Teach correct behavior
Discipline:	Scold, sometimes time out in kennel
Where would Pembroke spend the majority of the time:	Home w/ free roam of fenced in back yard.
Discipline:	Scold, sometimes time out in kennel Where would Pembroke spend the majority of the time: Home w/ free roam of fenced in back yard.
House dog or outside dog?	House dog
People at home during the day?	Yes
Where would dog eat?	Home – kitchen
Where would dog sleep:	I would like to say doggie bed in living room……but probably with one of my Girls ?
Play & exercise:	Walks and playing in our yard, we have two dog parks near our home, camping. Daily exercise.
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?	8ft wooden fence around the perimeter of our lot
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:	Grass 1.5 acre lot. Small garden, playhouse and swing set.
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?	Courtney Polak
Willing to train children?	Yes
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?
Are you willing to work on it if your new dog doesn’t get along with your current pets right away?	NA
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}