Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 12/12/2019 | 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: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Outgoing, Quiet, Playful, Energetic, Very Active |
Other preferences: |
Our husky mix is a very active dog, we take her on 4 walks/day minimum, and spend a lot of time at our local off-leash dog parks. Not to say a corgi would have to keep up with her, but we don't spend a lot of time hanging out in the backyard! | ||||||
Dog Ownership History | |||||||
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} | ||||||
Questions Regarding Motivation for Adopting and Intentions | |||||||
Who is this dog for? |
our family – the 2 of us, our 11-year-old husky mix rescue Mya, and 2 cats, Howard and Oz | ||||||
Why do you want a Pembroke? |
I grew up with corgis, and love them to pieces for their opinionated, talky selves. I love how they don't realize they are not the same size as the German Shepherd down the street, or that cats really don't want to be herded. I love them for their attitude! My sister currently has a Corgi and that has made me remember the good times with our family dogs and want one again. | ||||||
Activities planned with Pembroke: |
We do a lot of hiking – the Ice Age National Scenic Trail here in Wisconsin, regular visits to state parks and forests, a week on Washington Island. Our dog Mya loves going to the dog parks around us, so we spend a lot of time at those (and have made some great human and canine friends there). Swimming in local lakes and streams. | ||||||
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: |
Depends on the mistake. I would re-direct their attention to a more appropriate activity if possible. I would look to see what might have caused them to act that way – boredom, nervousness – and try to help them with that. | ||||||
Discipline: |
We don't have to discipline our current dog – she is perfect. She walks off-leash on voice command, returns to us when called 95% of the time. When we first got her as a rescue, she didn't know how to walk on a leash, so we took her to leash-training class where we discovered she is not motivated by treats, but by verbal rewards, so we use that technique mostly, telling her she's a good girl when she follows our commands. On the rare occasion where she hasn't listened well, I will reprimand her verbally, and then we try it again. | ||||||
Where would Pembroke spend the majority of the time: |
In the house. | ||||||
Discipline: |
We don't have to discipline our current dog – she is perfect. She walks off-leash on voice command, returns to us when called 95% of the time. When we first got her as a rescue, she didn't know how to walk on a leash, so we took her to leash-training class where we discovered she is not motivated by treats, but by verbal rewards, so we use that technique mostly, telling her she's a good girl when she follows our commands. On the rare occasion where she hasn't listened well, I will reprimand her verbally, and then we try it again. Where would Pembroke spend the majority of the time: In the house. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
We both have school-schedules, which means often there are free hours during the day for one of us to get home to take the dog for a walk. She is never alone in the house for more than 6 hours at a stretch, and usually it's more like 4 hours away. | ||||||
Where would dog eat? |
In the kitchen. There is a row of dishes for the various animals! | ||||||
Where would dog sleep: |
Wherever they would like! The bed gets crowded at times, but they make it work. Mya has her choice of dog beds, if she prefers not to be up on the people bed. | ||||||
Play & exercise: |
As mentioned above, we take our dog out for walks at least 4 times a day, and for longer adventures every weekend. We spend a LOT of time outside with her! | ||||||
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? |
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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: |
|||||||
Landlord permission: |
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Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
We live downtown, so our yard is small. The driveway takes up about half of the total space. We do not have a fence around the yard – the backyards of the neighbors on this side of our street form one large contiguous area used by children and chickens. Mya doesn't like being outside without one of us, so we don't leave her on a lead in the yard ever. Either one of us is with her there, or we are walking the neighborhood. (She refuses to use our yard to do her business!) | ||||||
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? |
Karen Bassler | ||||||
Willing to train children? |
Our children are both adults and do not live with us, although our son lives nearby and visits frequently. | ||||||
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? |
Yes, all of our current pets are friendly toward dogs. | ||||||
Are you willing to work on it if your new dog doesn’t get along with your current pets right away? |
Yes, of course! Both of our cats are totally chill with dogs, and Howard in particular would LOVE to be Mya's best friend, but she's more standoffish with him. | ||||||
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} |