State: {Applicant State:2} Date of Application: 07/12/2019 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:
0 months – 1 year (we rarely get dogs in this age group), 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, Quiet, Playful, Energetic, Very Active, Other (Please describe in the box below.)

Other preferences:
We would like to rescue a dog that is young-middle aged. It does not need to be under a year or two, but we would like to have a dog that can be our companion for a fair amount of years, as we will certainly fall in love fast. Our only specification besides this is that we need it to get along well with cats. Our cats have been with dogs before and are fine as well.

Previous dog owner?
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?

The Pembroke is for may girlfriend and I. We currently live in a 3 bedroom home together with our two cats. We have a wonderful fenced in yard as well. We have been wanting to get a dog to complete our family for the time being, but refuse to purchase one from the breeder. We both grew up with dogs, and now living together on our own we miss having one, though our cats are wonderful companions as well. Sarah is obsessed with Corgi's, and we would like to help save a life, while also saving money by adopting a rescue. We are in no-rush, and our only specification is that the dog must get along with cats. We take care of our 2 cats like they are our children, and would never want to endanger them with a dog that could be aggressive towards them. We are happy to take a middle-aged corgi, and gender is not important. We want what would be best for the dog as well. Thank you for your time ?

Why do you want a Pembroke?
My girlfriend and I have done significant research on the breed. While I am more open to rescue other breeds as well, my girlfriend really has her heart set on Corgis, so I insist that we rescue. I grew up with Shelties, so I am very used to hyper and vocal medium sized dogs. I also just moved out of a home with a dauschund with = aggression issues, so I have had a good amount of experience with obedience training and just dealing with the unexpected when it comes to taking care of these animals. My girlfriend has a family friend who owns two corgis, and we have spent much time with them, making us want one even more. We grew up with dogs all our lives, and feel a corgi will be the perfect fit in our new home. At the end of the day, we just care about saving a life.

Activities planned with Pembroke:
We would love to play with the dog a good amount! Our home has a decent sized flat yard with a good fence, and we would love for it to be able to run around outside with a good amount of freedom as well! We would love to cuddle with the dog and have it sleep with us at night if it likes. I oftentimes work from home, so the dog would have near-constant attention.

Aware that Pembrokes are busy, noisy dogs?

Money for basic care?


Money for unforeseen medical expenses?

Willing to house train?
Willing to do formal training? Yes

Do you have a veterinarian?


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:
The dog would be disciplined by perhaps being told to sit in its bed, and using a stern tone to display the wrongdoing. We would never dream of physically hurting the dog in anyway. We also will reward the dog with treats as to help teach it has done something well.

Nothing physical. I believe in being stern and addressing the dog with confidence and consistency.

Where would Pembroke spend the majority of the time:
The dog would spend most of the time in the house when we are not home (which is rare), in the yard, or with us. We also have my parents who live 5 minutes away who can take care of the dog.

Nothing physical. I believe in being stern and addressing the dog with confidence and consistency.
Where would Pembroke spend the majority of the time: The dog would spend most of the time in the house when we are not home (which is rare), in the yard, or with us. We also have my parents who live 5 minutes away who can take care of the dog.

House dog or outside dog?

House dog

People at home during the day?
Usually yes. Between the two of us, usually one is at least at home. I freelance mostly, so work is about 60/40 from home vs working in Chicago. My girlfriend works 5 minutes away from. the house, and can always take breaks to let the dog out and give attention. We have trustworthy neighbors as well.

Where would dog eat?
The dog would eat out of bowls on the kitchen floor, there is a sort of nook in a corner of the wall that would work perfectly.

Where would dog sleep:
The corgi would have a dog bed we will purchase, but we would love for it to sleep with us on our bed as well.

Play & exercise:
Because of our fenced in yard, the dog will have a good amount of time to play and excerices. We would walk twice a day, once in the morning, and once in the evening. I oftentimes work from home, so the dog will have plenty of attention and play time,.

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?
We have a fence that touches the house covering the entire backyard. It is a wood fence on two sides, and a chained fence on the other two sides. It is about 5 feet tall.

Living arrangements:
Rent/lease 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?
Yes, you may contact my landlord.

Lease allow dogs:
Yes, my lease permits dogs.

Landlord permission:
Yes, my landlord is fine with me owning a Pembroke

Restrictive covenants?
Not applicable

Breed/size restrictions?

Description of yard:

* I would like to note that because we rent from a large company and not an individual, we do not have specific contact info for you. The company is called Pathlight Management. If we do get the go-ahead to proceed with the application from you, I will then notify the company of the dog in which we must put down a deposit, and then will provide you. with conact info of the rep who is assigned to us ? We were already told we can have a dog, just need to fill out paperwork first when it happens.

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?
Both Jarod and Sarah.

Willing to train children?
There will be no children around, but if we have children in the future, we would of course.

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?
Of course, we absolutely will.

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}