Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 04/12/2020 | 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: |
5 years – 10 years, 10 years + | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful |
Other preferences: |
Should enjoy car rides – not prone to motion sickness! | ||||||
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? |
Household pet and canine companion for Susan and Bill. | ||||||
Why do you want a Pembroke? |
My husband and I have recently moved into an apartment from a home with a fenced yard; we have owned Labrador retrievers for 30 years, 2 raised as pups and 10 adopted as "senior" rescues from a breed-specific rescue group. We are lonely without a dog!, our building size limit is 25 lbs ("give or take"), and we do not have experience with "small" dogs. I want a small dog with the temperament and personality of a big dog; corgis are breed to do a dog's work, I don't care about the hair (can't be any worse than labbie hair). My experience is limited to meeting the corgis of acquaintances and what I've learned about the breed from on-line research, canine-match questionnaires, and all-breed guidebooks. | ||||||
Activities planned with Pembroke: |
Long walks on nearby trail, "relieve" outings in large fenced dog park for building; would consider obedience / agility classes / etc. if activity level of the specific dog adopted would enjoy this. | ||||||
Aware that Pembrokes are busy, noisy dogs? |
Yes | ||||||
Money for basic care? |
Yes | ||||||
Money for unforeseen medical expenses? |
Yes | ||||||
Willing to house train? |
No 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: |
???? After 30 years as a dog owner, I'm not sure what this means! Dogs are dogs!!! If s/he pees or poops in the house – shame on owner for not paying better attention. If s/he gets caught chewing on something that isn't its chew thing, take it away and gently scold. If s/he eats something it shouldn't – trip to the vet if it's toxic or harmful. | ||||||
Discipline: |
Gentle scolding; time-outs (down-stay with supervision for a few minutes, then a happy "free"). | ||||||
Where would Pembroke spend the majority of the time: |
Our hope is right by the side of his/her new human mom and dad! In bed, following around the house, riding in the car for adventures, on walks, free run of the apartment unless s/he'd be happier in a crate when alone (which wouldn't be often – my husband doesn't drive and is pretty much homebound). | ||||||
Discipline: |
Gentle scolding; time-outs (down-stay with supervision for a few minutes, then a happy "free"). Where would Pembroke spend the majority of the time: Our hope is right by the side of his/her new human mom and dad! In bed, following around the house, riding in the car for adventures, on walks, free run of the apartment unless s/he'd be happier in a crate when alone (which wouldn't be often – my husband doesn't drive and is pretty much homebound). |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes – corgi might spend a few hours alone some mornings but generally full-time human companionship. | ||||||
Where would dog eat? |
in the kitchen | ||||||
Where would dog sleep: |
We hope in bed with mom and dad! otherwise on a dog bed in our bedroom. | ||||||
Play & exercise: |
Indoor games; leash walks (30 min twice times a day), quick stretches-potty breaks as needed. Nearby off-leash dog park if s/he likes canine interaction. | ||||||
How will you exercise your dog? |
Both on leash and restrained to the yard | ||||||
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? |
6 foot chain link dog exercise area outside of apartment building. | ||||||
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: |
|||||||
Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
Yes | ||||||
Description of yard: |
PER ABOVE "CONSENT": Building management requires meet-and-greet with specific dog to determine whether or not they will consent to allowing it to live in the building. | ||||||
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? |
Susan | ||||||
Willing to train children? |
Childfree home, no children/grandchildren visitors | ||||||
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? |
not applicable – would be a one-dog family. | ||||||
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} |