Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 09/30/2019 | 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: |
Any age | Gender preferred: |
Either a Male or a Female | Color preferred: |
Red & White, Red Headed Tri | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Energetic, Very Active |
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? |
This corgi is for my husband and I. We were blessed to live with my Pippin for five years. He passed away six weeks ago and it's so quiet and empty in the the house without a corgi. He was a red and white and was the sweetest little boy ever. I would like to give another corgi a forever home. My Pippin was a rescue as well. We are retired, have the ability to care for a dog the way they should be. He or she would sleep with us, hang out, garden, vacation, watch tv, go walking, just like my little boy did. My nephew told me that he'd like to come back in the next life as my dog because of the care I give them. | ||||||
Why do you want a Pembroke? |
My Pippin was my first corgi. He was a rescue, he taught me to love the breed and now I can't see my life without at least one corgi. My little boy was my heart dog that passed at age 11 from a nasal tumor. I need some time to heal my heart so I can be ready for my next little buddy, but I am patient and I know I can give another corgi a great life. | ||||||
Activities planned with Pembroke: |
We would walk in the park, down to the lake, take him or her on errands (weather permitting). I don't leave dogs in cars when it's hot. I would like to teach some scent training, some agility, play in the house, watching tv, just treat them as a full family member. | ||||||
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: |
Say OOPS and try whatever again | ||||||
Discipline: |
I believe in positive reinforcement training. I don't like people yelling at dogs, jerking the leash, rubbing nose in messes. etc. Dogs are smart creatures with feelings, they just need to learn our ways and we need to learn theirs. Training should be in short durations but fun | ||||||
Where would Pembroke spend the majority of the time: |
With us where ever possible | ||||||
Discipline: |
I believe in positive reinforcement training. I don't like people yelling at dogs, jerking the leash, rubbing nose in messes. etc. Dogs are smart creatures with feelings, they just need to learn our ways and we need to learn theirs. Training should be in short durations but fun Where would Pembroke spend the majority of the time: With us where ever possible |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes, we are both retired | ||||||
Where would dog eat? |
My Pippin had his dishes in the kitchen, that's where I would put them again | ||||||
Where would dog sleep: |
Our dogs are full family members, they can sleep with us if they choose. I have a ramp and stairs for a corgi to get up on a bed or a couch. I trained my boy to use the stairs easily | ||||||
Play & exercise: |
My corgi had the full run of a fenced yard, he followed me to the gardens, was outside with me a lot. On bad weather days we played ball inside, find the toy, I did training, I can keep a dog busy. | ||||||
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? |
I have a 1/3 acre fenced back yard with chain link | ||||||
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? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
I have a fenced yard with grass, no pool or any other dangers. There is a herd of yorkies that live next door and they would run back and forth the fenceline with my Pippin and have great fun doing it | ||||||
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? |
Tammy | ||||||
Willing to train children? |
We don't have small children or grand children but when ever I was walking Pippin I'd explain to the kids who wanted to pet him how to approach slowly, one at a time, and to be gentle | ||||||
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? |
Absolutely | ||||||
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} |