State: {Applicant State:2} Date of Application: 11/04/2019 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:
Any age
Gender preferred:
Either a Male or a Female
Color preferred:
Any color
Activity level:
Couch Potato, Outgoing, Quiet, Playful

Other preferences:
We regularly interact with another family and their pug, so the dog being able to socialize is a must.

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?

Our family.

Why do you want a Pembroke?
Well, for starters, Corgi's are the cutest dogs in the world. But other than that, Corgis fit the perfect niche of Amanda's desire for a smaller dog, and Matt's desire for an intelligent and active one.

Our experiences with Corgis have been overwhelmingly positive. Amanda's uncle and a two of our friends have corgis as well. In both cases, we have had time to interact and play with the Corgis both with and without their owners present. It has always been an excellent time.

Our research has only really touched into the basics of the breed, mostly consulting the Pembroke Welsh Corgi Club of America's website and wikipedia.

Activities planned with Pembroke:
We are looking forward to love and play with the Corgi, and taking it out to play with other dogs. Matt is looking forward to take the Corgi on long walks or even runs if the it is able to. Matt is also looking forward to training a Corgi, whether it is only the basics, or more complicated games like Treibball (boy those youtube videos were quite a rabbit hole once I stumble on them).

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:
Correct it via training, and positive reinforcement of desired behaviors.

A firm, commanding voice (not shouting), looks of disappointment, and a time out if necessary. Physical punishment is never an option.

Where would Pembroke spend the majority of the time:
With us, in the house.

A firm, commanding voice (not shouting), looks of disappointment, and a time out if necessary. Physical punishment is never an option.
Where would Pembroke spend the majority of the time: With us, in the house.

House dog or outside dog?

House dog

People at home during the day?
No, though Matt is able to bring his pets to work provided they are well behaved.

Where would dog eat?
Near us where we are eating – mainly at the kitchen table.

Where would dog sleep:
On a sleeping pillow in the bedroom.

Play & exercise:
We will walk the corgi at least twice daily, and regularly (averaging around bi-weekly) interact with a couple with a pug. We will also take the corgi out to dog parks to play on the weekends when able to, and there will certainly be a lot of play at home as well. Especially fetch.

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?

Description of yard:

There are farm side rail fences on 2 sides of the lot, and a small water feature in another corner (just 2 small ~1 yard diameter pools with one cascading water into the other. Otherwise we have a small fenced in garden and a variety of trees and open space. It is only .2 acres in Madison so it isn't huge by any means.

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?

Willing to train children?
Absolutely. And the best way is to learn as you grow up, that way you are familiar with animals and learn both how to care for them, but also how to safely interact with them.

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?

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}