Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 08/25/2019 | Referred by: | Other | ||
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: |
Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful |
Other preferences: |
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Dog Ownership History | |||||||
Previous dog owner? |
Yes | ||||||
Dog 1 |
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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 wife and I | ||||||
Why do you want a Pembroke? |
My wife and I are ready to add a 4-legged friend to our family! We’ve done our research and we believe a Corgi would fit perfectly in our life. My wife is a 4th grade teacher and I work at The Boys and Girls Club at 2:00, so the dog would only be alone for 1-2 hours during the week. We both are fairly active and go on long walks every night so adding a dog to that just makes it even better. We have met other Corgis before and we love how social they are. They are not scared like other dogs, even though they’re smaller. My wife and I are very social so we plan on taking our dog whenever we can and having a dog that isn’t freaking out is a huge plus. | ||||||
Activities planned with Pembroke: |
We plan on bringing our dog along on walks every day and the dog park that’s down the street on the weekends. We will bring it to social events when aloud to and my parents house. We also plan on doing puppy training. | ||||||
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: |
It depends on the situation, but if it was peeing in the house, I would immediately take the dog outside. After taking the dog out many times, when it does pee, I would reward the pup with a treat and praise him. This would condition the dog that peeing outside is a good thing and that that is where it should be done. | ||||||
Discipline: |
With past dogs, I had this can of air. It doesn’t scare the dog, but it gets their attention. If the dog would go for my food, for example, I would spray the can, sternly say no, and redirect them to their food (I always gave my dog’s 3 meals of the day during my 3 meals of the day) | ||||||
Where would Pembroke spend the majority of the time: |
Inside. | ||||||
Discipline: |
With past dogs, I had this can of air. It doesn’t scare the dog, but it gets their attention. If the dog would go for my food, for example, I would spray the can, sternly say no, and redirect them to their food (I always gave my dog’s 3 meals of the day during my 3 meals of the day) Where would Pembroke spend the majority of the time: Inside. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
All day except from 2:00 to 4:00 during the week and that is the maximum. | ||||||
Where would dog eat? |
In the kitchen | ||||||
Where would dog sleep: |
In the cage early on, but to be honest it will most likely end up in our bed after a while. | ||||||
Play & exercise: |
A daily walk, maybe even 2 (me in the morning and my wife in the evening) and the dog park nearby. We will play inside as well. | ||||||
How will you exercise your dog? |
Both on leash and restrained to the yard | ||||||
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? |
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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: |
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Landlord permission: |
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Restrictive covenants? |
No, the condo covenants do not prevent me from having a dog. | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
We have a big open front yard and fenced dog park walking distance away | ||||||
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? |
Ryan Davis | ||||||
Willing to train children? |
Yes, but we don’t have 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? |
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Are you willing to work on it if your new dog doesn’t get along with your current pets right away? |
Yes | ||||||
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} |