Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 08/06/2019 | 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: |
1 year – 3 years, 3 years – 5 years | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Playful, Energetic |
Other preferences: |
|||||||
Dog Ownership History | |||||||
Previous dog owner? |
No | ||||||
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? |
Both of us. Greg and Julie Wilson | ||||||
Why do you want a Pembroke? |
Our daughter had been living with us and for 2 years her mixed Corgi lived with us. We love her, love her activity and non-activity levels. Love walking her, love her over all willingness to learn and train. We just love this breed and know a veterinarian who has one and her son has 2 of them. Nothing but great things have been said about this particular breed. Yes we have researched we are aware of dental hygiene, the need for weigh control for back issues. We know about the vocalization and we had a can of air for my daughter's dog to help control this when she was indoors. When she is outside we let her "talk" it out. | ||||||
Activities planned with Pembroke: |
inside toy play, walking, training classes and other dog socialization. I loved going to training classes and learning more about my daughter's dog as well as all the others in the class. It was great to see the interaction. | ||||||
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: |
Positive reinforcement, and rest between training times. | ||||||
Discipline: |
"No" spoken for bad behavior and "Yes" emphasized for good behavior. Positive reinforcement with mini-treats if the dog is treat incentive, or a toy if toy is the preference | ||||||
Where would Pembroke spend the majority of the time: |
At our home. If some time is needed to get acquainted while we are out of the house for a brief time I have 2 sizes of crates. I prefer the dog to be in the room with us or adjacent room. At night it would have it's own bed beside us for night time resting. | ||||||
Discipline: |
"No" spoken for bad behavior and "Yes" emphasized for good behavior. Positive reinforcement with mini-treats if the dog is treat incentive, or a toy if toy is the preference Where would Pembroke spend the majority of the time: At our home. If some time is needed to get acquainted while we are out of the house for a brief time I have 2 sizes of crates. I prefer the dog to be in the room with us or adjacent room. At night it would have it's own bed beside us for night time resting. |
||||||
House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes, since I work part time I am in and out of the house. Husband is semi-retired and is home no later than mid-afternoon | ||||||
Where would dog eat? |
An area in the kitchen where it can't be disturbed if I am busy in the kitchen, with 2 separate bowls for water and kibble | ||||||
Where would dog sleep: |
In it's own bed in our room if it wishes | ||||||
Play & exercise: |
at least 2 walks a day- 15-30 minutes each. During better weather a park district dog park with lots of running space. A park about 1/2 block from us for larger space for playtime on a longer leash. We have plenty of sidewalks for walking. Dog socializing maybe once a month with a doggie day care at the same Pet Smart I would use for the veterinarian service. | ||||||
How will you exercise your dog? |
On leash | ||||||
Fenced yard? |
No, I don’t have a fenced in yard. | ||||||
Willing to pick up dog waste? |
Yes, I will clean up after my dog. | ||||||
Willing to use a crate? |
|||||||
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: |
No pool….medium sized front yard, small back yard larger size side yard. | ||||||
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? |
Julie | ||||||
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? |
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 Do not plan to adopt any other pet | ||||||
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} |