Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 04/29/2020 | Referred by: | Friend | ||
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: |
0 months – 1 year (we rarely get dogs in this age group), 1 year – 3 years | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Playful |
Other preferences: |
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Dog Ownership History | |||||||
Previous dog owner? |
Yes | ||||||
Dog 1 |
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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? |
For Andy and Wendy Uhl as above | ||||||
Why do you want a Pembroke? |
I have done research on line and spoke with a friend who is very knowledgeable about dog breeds and referred me to your site. I love herding dogs and am used to training them. | ||||||
Activities planned with Pembroke: |
Walks, play with toys and we have a large yard, just under 3 acres. Lots of opportunities for playing outside. We live by a little lake. Our previous sheltie, also not a water dog, loved going to the lake and splashing in the water near the shore, always supervised. | ||||||
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: |
Say "No" and redirect the dog to a more appropriate behavior. Use positive reinforcement, praise and treats, when they are doing the required behavior. | ||||||
Discipline: |
Remove the dog from the area of the wrong behavior and redirect. I have used water spray bottles in the best. It works with some dogs better than others. | ||||||
Where would Pembroke spend the majority of the time: |
Mostly in the house, and then in the back yard. | ||||||
Discipline: |
Remove the dog from the area of the wrong behavior and redirect. I have used water spray bottles in the best. It works with some dogs better than others. Where would Pembroke spend the majority of the time: Mostly in the house, and then in the back yard. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes, especially since we both just retired. | ||||||
Where would dog eat? |
Our previous dogs at a variety of foods, our last dog, a Sheltie, ate Royal Canin. We were recommended not to give her a grain free diet. I would always check with the Vet for diet recommendations. | ||||||
Where would dog sleep: |
Initially, in a crate near us, and then in the house/dog bed. We have never had our dogs sleep with us in our bed. | ||||||
Play & exercise: |
When the weather is nice there is plenty of room to play outside and take walks. Play with balls etc. We do have a fairly large house and room to run around. | ||||||
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? |
Our back yard has a 5 foot high chain linked fence with a gate with a latch. Our previous German Shepherd did jump over it once, but a corgi would not be able too. Our Sheltie was well contained. | ||||||
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? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
We live on a large property on a small lake in Western Waukesha Co. We don't have a swimming pool. Our fenced in area is in the back on the lake side. We have a run set up in front the yard where we would put our dog when we were working in the garden. Our dogs are always supervised. | ||||||
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? |
Wendy and Andy | ||||||
Willing to train children? |
We have no young children in our home. We have granddaughters who visit occasionally, but live out of state and have been taught about pets. | ||||||
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? |
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Are you willing to work on it if your new dog doesn’t get along with your current pets right away? |
NA | ||||||
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} |