State: {Applicant State:2} Date of Application: 01/10/2020 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:
Color preferred:
Any color
Activity level:
Couch Potato, Quiet

Other preferences:
My apartment is not very large so I do not want a dog that is super active.

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?


Why do you want a Pembroke?
I have done research and I think they would be the perfect breed for me. I am young and very physically active and would love to devote my attention to my dog and its well being. I am single and they would receive all of my undivided attention. One of my best friends also has a corgi and I love their perfect size and the balance of their personality between being very active but also able to be quiet. I appreciate their personality of being small but not “yippee”.

Activities planned with Pembroke:
I would go on tons of walks and certainly cuddle the dog very often. I would socialize them at parks and bring them around with me in the car whenever necessary, wherever they comfortable.

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:
I would raise my voice and let them know they were wrong, and not to do that, but nothing more.

Time out in their crate (if applicable).

Where would Pembroke spend the majority of the time:
In my apartment, out of a crate.

Time out in their crate (if applicable).
Where would Pembroke spend the majority of the time: In my apartment, out of a crate.

House dog or outside dog?

House dog

People at home during the day?
Yes. I work from home on occasion.

Where would dog eat?
In my apartment.

Where would dog sleep:
In my apartment.

Play & exercise:
A lot. I would walk them at least once a day, more frequently twice a day. There is space to socialize dogs on my apartment and if frequently take them to parks, on walks in public places, etc.

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:
Rent/lease 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?
Yes, you may contact my landlord.

Lease allow dogs:
Yes, my lease permits dogs.

Landlord permission:
Yes, my landlord is fine with me owning a Pembroke

Restrictive covenants?
Not applicable

Breed/size restrictions?

Description of yard:

I do not live in a house.

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?
Kate Shumway

Willing to train children?
I do not have children.

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?

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}