State: {Applicant State:2} Date of Application: 01/11/2020 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:
5 years – 10 years, 10 years +
Gender preferred:
Either a Male or a Female
Color preferred:
Any color
Activity level:
Couch Potato, Quiet

Other preferences:
Ok with cats in the home

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?
Corgis are my passion! Their little stubbly legs make my heart thump! I’ve researched for years, and I feel like now is the right time to welcome a corgi into my home.

Activities planned with Pembroke:
Hang out around my home, take them along to social activities with family, outside excursions (on flat ground; Nebraska isn’t really known for its elevation)

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:
Understanding-based training is a very important part of correcting behavior without making a dog feel like it’s done something very wrong. Stern, yet understanding reinforcement.

Treat-based training, squirt bottle training, and stern voice.

Where would Pembroke spend the majority of the time:
In my apartment with myself or in my office.

Treat-based training, squirt bottle training, and stern voice.
Where would Pembroke spend the majority of the time: In my apartment with myself or in my office.

House dog or outside dog?

House dog

People at home during the day?
There will not; however I work a two-minute walk from my home so I go home frequently during the day.

Where would dog eat?
At one specific location in my kitchen.

Where would dog sleep:
In my bed or an open crate in my bedroom; whichever they feel more comfortable in

Play & exercise:
There’s a dog park in close proximity to my home. There is also a huge open space behind my home. I have friends with dogs, and I’d like for them to socialize.

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:

Not applicable

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?
I don’t plan on having children. I’m single as a Pringle.

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?
Of course. It’s important to me that my pup feels comfortable in their new environment.

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}