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Applicant IL
State: {Applicant State:2} Date of Application: 02/15/2020 Referred by: Other
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, 3 years – 5 years
Gender preferred:
 Either a Male or a Female
Color preferred:
 Any color
Activity level:
 Couch Potato, Outgoing, Quiet, Playful, Energetic, Very Active

Other preferences:
 Prefer one that doesn’t bark incessantly, is house trained and crate trained, travels ok in cars (doesn’t get sick), and doesn’t have special needs.

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}

Who is this dog for?

 Me and my 10 yr old daughter

Why do you want a Pembroke?
 I have done extensive research on this breed and have friends and neighbors who are owners so I’ve talked to owners and been around this breed. I grew up with herders (German shepherds) and owned a Sammy-Golden retriever-chow mix for 14 years until he passed away Feb 2019. I want a dog that is smaller but has herder characteristics. There dogs tend to be smart, trainable, and loyal. I just want a smaller breed this time around. Also, my daughter has spend a considerable amount of time with Winston, our neighbors Corgi, and she has decided this is the dog for her. I want her to be invested and choosing the dog breed is part of that process. We are ready for a little guy or gal to join our family of two.

Activities planned with Pembroke:
 Walking, traveling, lake time, dog parks, cuddling, yard play, learning new tricks, visiting grandma in Nebraska at her farm, going to work with mom at the university, and so on. I anticipate this new family member will do everything with us!

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: 		It depends on the mistake, but typically the best way to train dogs is via positive reinforcement. If a dog is chewing on a shoe, you take the shoe away and replace it with an appropriate chew toy and praise them when they do the right thing.

Discipline:
 See above.

Where would Pembroke spend the majority of the time:
 With us! We do travel a bit between homes in Illinois and Missouri. We need a dog that is comfortable traveling and can adjust to new environments, people, other pets, etc.

Discipline:
 See above.
Where would Pembroke spend the majority of the time: With us! We do travel a bit between homes in Illinois and Missouri. We need a dog that is comfortable traveling and can adjust to new environments, people, other pets, etc.

House dog or outside dog?

 House dog

People at home during the day?
 Yes and no. I work from home a lot. The dog wouldn’t be alone for more than a few hours on any given day. I can also bring him or her to work with me. My campus is less than 10 minutes from my house so i can go home to check on the dog too. I intend to work primarily from home, or take the dog to work with me, when the dog is first adopted so they aren’t left alone.

Where would dog eat?
 Kitchen

Where would dog sleep:
 In my or my daughters bedroom on a dog bed

Play & exercise:
 Lots! We have a large yard and are very familiar with having to walk a dog multiple times a day. Our house is also large enough to run around as well.

How will you exercise your dog?
 On leash

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?
 Wooden with chain link

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?

Lease allow dogs:

Landlord permission:

Restrictive covenants?
 Not applicable

Breed/size restrictions?
 No

Description of yard:

 Just a large fenced yard with a back deck and patio.

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?
 Jacquelyn

Willing to train children?
 Yes. However, my daughter is already well trained to interact with dogs. She has had a dog since birth up, until last year when he died. She has been around many other dogs as well.

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?

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}