Untitled_2745

Applicant IL
State: {Applicant State:2} Date of Application: 12/31/2019 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:
 0 months – 1 year (we rarely get dogs in this age group), 1 year – 3 years
Gender preferred:
 Either a Male or a Female
Color preferred:
 Any color
Activity level:
 Couch Potato, Outgoing, Quiet

Other preferences:
 Easily trainable and will be considered to train to become a psychiatric service animal.

Previous dog owner?
 No
 
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?

 Mackenzie. She needs an emotional support animal for her severe anxiety disorder.

Why do you want a Pembroke?
 I want to adopt a corgi because I think they are adorable, I have done a little research and their average size, weight, and personality all fit into what I need.

Activities planned with Pembroke:
 I would walk with my dog daily, go to stores that allow dogs, and basically do as much as I can with my dog. I need constant help with my anxiety, so I do not plan to be separated from my dog often.

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?

 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 discipline them in a calm yet firm way. For example, if they made a mess, I would say "no," point at the mess, and make sure they look at the mess.

Discipline:
 "Heel," put them in a "sit/stay," "no," "come," but NEVER abuse.

Where would Pembroke spend the majority of the time:
 Wherever I am at, whether that is in my dorm or out doing things. I spend a lot of my time outside doing homework and hanging with friends.

Discipline:
 "Heel," put them in a "sit/stay," "no," "come," but NEVER abuse.
Where would Pembroke spend the majority of the time: Wherever I am at, whether that is in my dorm or out doing things. I spend a lot of my time outside doing homework and hanging with friends.

House dog or outside dog?

 House dog

People at home during the day?
 Yes.

Where would dog eat?
 Whatever nutritional food it needs.

Where would dog sleep:
 In its' own bed and/or in my bed with me.

Play & exercise:
 I would make sure to add time in my schedule to play in the morning, afternoon, and evening. My schedule allows a lot of flexibility to play with my dog and take them outside.

How will you exercise your dog?
 Both on leash and restrained to the yard

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:
 Student in dorm

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?
 Yes, the condo covenants do prevent me from owning a dog.

Breed/size restrictions?
 Yes

Description of yard:

 My parents' home, where I live when I am not at school, has a huge grassy backyard. We live by a park trail they we take walks on as well.

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?

 No, I will not 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?
 Mackenzie Cirksena

Willing to train children?
 I do not have any kids or have any young children in my family.

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.

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}