Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 11/13/2019 | 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: |
0 months – 1 year (we rarely get dogs in this age group), 1 year – 3 years, 3 years – 5 years | Gender preferred: |
Female | Color preferred: |
Red Headed Tri, Black Headed Tri, Sable & White | Activity level: |
Outgoing, Playful, Energetic, Other (Please describe in the box below.) |
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? |
I am looking for a new forever friend to keep me company at home | ||||||
Why do you want a Pembroke? |
I lost my corgi, Boo Boo 2 years ago. She was 12 and we had to put her down due to old age. I knew for a fact that I wanted another corgi but I wanted to wait until the time was right. God came to me in a dream one night this past week and told me now was the time to do it. I have always loved corgis due to their energy cleverness and loyalness. Boo Boo was my best friend and I rescued her when she was a puppy and I got to watch her grow up and nurture her into the amazing dog she was. I would love to be able to do that with another corgi too. | ||||||
Activities planned with Pembroke: |
I love running in my free time and participate in marathons. Boo Boo was always my running partner when I went for runs so I would take the new dog on runs too. I also will make sure to do basic and advanced training with the dog. I'm always up for a game of fetch if my dog is and would give it lots of attention whenever it needs or wants it | ||||||
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: |
I would teach it what is right and what is wrong and correct my dogs behavior if needed | ||||||
Discipline: |
I would use my voice and reinforce good behavior with lots of treats | ||||||
Where would Pembroke spend the majority of the time: |
They would spend most of their time at home with me or with me at my work since I am a self-employed Videographer that does on-site location shoots. As long as it is ok with the customer. | ||||||
Discipline: |
I would use my voice and reinforce good behavior with lots of treats Where would Pembroke spend the majority of the time: They would spend most of their time at home with me or with me at my work since I am a self-employed Videographer that does on-site location shoots. As long as it is ok with the customer. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
no | ||||||
Where would dog eat? |
in the kitchen | ||||||
Where would dog sleep: |
In the bed with me | ||||||
Play & exercise: |
I go on runs every day so I would take them with me. I will also play with them whenever they seem hyper or excited. They will be spoiled with all the toys they could ever want to play with when I am out of the house | ||||||
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? |
wood fence . 8 ft. tall around the entire house. Front gate securely latches to ensure that the dog can't get out | ||||||
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: |
large backyard with 2 large trees that provide shade. back patio area with fence around the whole 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? |
Bailey Wasmund | ||||||
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? |
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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? |
I don't have any other pets, but I will make sure they work out together | ||||||
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} |