Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 03/13/2020 | 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: |
Any age | Gender preferred: |
Female | Color preferred: |
Any color | Activity level: |
Outgoing, Playful |
Other preferences: |
Needs to get along with 2 cats | ||||||
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? |
Myself. I already have a corgi mix but she needs a friend. I also have 2 cats. I love the breed | ||||||
Why do you want a Pembroke? |
I love the size, the personalities, and easy temperment (my experience) of the corgis/mix I have owned. They are easy to train & play with. They are smart & fun to train. I fall in love wth every one I see. | ||||||
Activities planned with Pembroke: |
Hopefully a new dog would give my dog a companion. She was a puppy mill breeder dog & she lacks knowing how to play. I do walk her & take her to the dog park but other dogs give up on her shyness but on occasion she will forget to shy & plays. She has good dog behavior, no aggression…more passive. I would love to share my home with another dog & also would like to give my dog a friend/companion. My cats are used to dogs. I am only looking for corgis or corgi mixes. | ||||||
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: |
With repetition and support | ||||||
Discipline: |
Firm direction as needed, but always with love. I use distraction if needed eg go for a walk if bad behavior is due to restlessness. I spoil my dog with toys & love. | ||||||
Where would Pembroke spend the majority of the time: |
In my home with walks during day. I work from home | ||||||
Discipline: |
Firm direction as needed, but always with love. I use distraction if needed eg go for a walk if bad behavior is due to restlessness. I spoil my dog with toys & love. Where would Pembroke spend the majority of the time: In my home with walks during day. I work from home |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes me…but I do leave at intervals for a short periods. | ||||||
Where would dog eat? |
In the kitchen with other dog & cats | ||||||
Where would dog sleep: |
It would be welcome on my bed, I have dog/cat beds for each animal. | ||||||
Play & exercise: |
2-4 walks a day & for most of year go to dog park to socialize | ||||||
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? |
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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: |
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Landlord permission: |
|||||||
Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
Partially fenced in, I have a small pong 2'X2', lots of gardens, room for a smaller dog to run, live close to dog park. | ||||||
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? |
No, some members of the family do not want 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? |
myself | ||||||
Willing to train children? |
No kids but my friends have kids. They use caution with my current dog | ||||||
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, my cats have only ever known dogs in home, my family & friends bring their dogs & we do not usually have any issues. Plently of room for cats to perch or hide if they are not in the mood. Cats are not aggressive towards dogs. Gracie & Sheena are more bonded. | ||||||
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} |