Untitled_2579

Applicant IL
State: {Applicant State:2} Date of Application: 09/17/2019 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:
 1 year – 3 years
Gender preferred:
 Either a Male or a Female
Color preferred:
 Any color
Activity level:
 Couch Potato, Outgoing, Quiet, Playful, Energetic

Other preferences:

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}

Who is this dog for?

 Kate Kazemba – Me

Why do you want a Pembroke?
 My very special Pembroke Welsh corgi, Sera, was diagnosed with cancer at the age of 13. She passed away in March of 2016. I have always had a special place in my heart for corgis. I love their strong and unique personalities and their independent nature. Sera was a special friend, and we spent a lot of time together. I am looking to adopt an older corgi to give a special dog a loving home.

Activities planned with Pembroke:
 Walk twice a day, longer walks in nature on weekends. Hang out and play with toys. Camping trips and perhaps agility courses as appropriate for an adult adoption.

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: 		Redirect, talk to him/her. Move on and figure out how to prevent it in the future, such as change my routines or provide more training for the Pembroke.

Discipline:
 Positive training, treats, proximity, crate training.

Where would Pembroke spend the majority of the time:
 With me. Walking, I can bring a dog to work. In my house.

Discipline:
 Positive training, treats, proximity, crate training.
Where would Pembroke spend the majority of the time: With me. Walking, I can bring a dog to work. In my house.

House dog or outside dog?

 House dog

People at home during the day?
 Yes

Where would dog eat?
 He/she would have a designated eating space of his/her own in the kitchen. Corgi's like their own dish.

Where would dog sleep:
 In my bedroom, on the floor.

Play & exercise:
 Walk twice a day. Play in the yard with me and throw toys. Everyday. Longer on weekends – I spend a lot of time in nature where it is appropriate for a dog, such as state parks.

How will you exercise your dog?
 On leash

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?
 Chain link, 4-foot, two sides, 6-foot wood one side, 4-foot iron 4th side.

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 yard with several trees, roses, and other perennials. Fenced as previously described. Enough room for a corgi to exercise with throw toys and my supervision.

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?
 Kate Kazemba

Willing to train children?
 My children are now adults. When I had children and puppies, we all knew how to care for animals. They now have pets of their own.

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?
 There are no current pets, and I doubt there will be any added in the future.

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}