Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 04/03/2020 | 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: |
3 years – 5 years, 5 years – 10 years, 10 years + | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Outgoing, Quiet, Playful |
Other preferences: |
I would not be able to adopt a corgi that incessantly barks as I live in a townhome community and share a common wall. Normal "I see a squirrel" or "mail man is at the door" stuff is OK. | ||||||
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? |
Self | ||||||
Why do you want a Pembroke? |
I have had a love for this breed from the first time I saw a picture of the Queen with her Corgis on a blanket in the Scottish highlands. Took me 35 years to get one but I did. I have had three rescue Pembroke Corgis. Sugar, my first for 6 years until she passed from cancer, Roger #2 for 8 years and he passed from a brain tumor, and Tater Tot for 3 years and he just passed from DM. | ||||||
Activities planned with Pembroke: |
Lots of walks and socializing with my friends that have dogs in the neighborhood. I would also love to try agility and/ or a therapy dog for nursing homes. | ||||||
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: |
Train them into the correct behavior or action. I am not personally a fan of "clicker" training but I do very much like to use positive verbal reinforcement. I have a certified trainer that I use to assist me just to make sure my timing is correct. | ||||||
Discipline: |
A stern no. NEVER physicals discipline. I try to turn it around with a way to do positive reinforcement. ie. going potty inside will turn into more frequent trips outside with much praise for the correct behavior. Having 3 Corgis before I understand how to be stern but not mean or a pushover. | ||||||
Where would Pembroke spend the majority of the time: |
During the work week the dog will be at home Kenneled until I can trust them on their own. I do have a dog walker that comes every day at lunchtime for a half hour. On the weekends I spend most of the weekend with the dog at home, or walks or a park. In addition to the noon walk I do walk my dos 3 additional times: Morning, after work and bedtime. | ||||||
Discipline: |
A stern no. NEVER physicals discipline. I try to turn it around with a way to do positive reinforcement. ie. going potty inside will turn into more frequent trips outside with much praise for the correct behavior. Having 3 Corgis before I understand how to be stern but not mean or a pushover. Where would Pembroke spend the majority of the time: During the work week the dog will be at home Kenneled until I can trust them on their own. I do have a dog walker that comes every day at lunchtime for a half hour. On the weekends I spend most of the weekend with the dog at home, or walks or a park. In addition to the noon walk I do walk my dos 3 additional times: Morning, after work and bedtime. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
No, not during the work week but I do have a dog walker come daily at lunch for 1/2 hour. She is a HUGE fan of corgis so a lot of times she will spend extra time in the house with the dog. I trust her implicitly so she can come and go as she pleases. | ||||||
Where would dog eat? |
They would eat in the breakfast room | ||||||
Where would dog sleep: |
Either a open kennel or dog bed next to my bed. They will find a spot most comfortable. All three of my dogs needed to be within eye shot of me. | ||||||
Play & exercise: |
I walk my dogs 3 times a day in addition to the noon walk on the weekdays. Weekends I generally go on a 2-3 mile walk Sat and Sun. If they take to playing ball then we can do that in the basement or I like some dog parks too. | ||||||
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? |
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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: |
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Restrictive covenants? |
No, the condo covenants do not prevent me from having a dog. | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
No, I am in a townhome complex and we have a small back yard that I do garden in. It is not fences so I ALWAYS have my dogs on a leash outside of the house, As I mentioned I do have a tether ouside in the back so the dog can hang out with me and roll around in the grass. | ||||||
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? |
Self | ||||||
Willing to train children? |
N/A, I have no 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? |
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} |