Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 05/11/2020 | 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: |
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: |
Red Headed Tri, Black Headed Tri, Sable & White | Activity level: |
Outgoing, 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? |
Our family – Tiffany, Ken, Zoe (16) and Ben (12). | ||||||
Why do you want a Pembroke? |
In general, Pembroke Corgis are a great fit for what our family is looking for in a pet – personable, playful, and adoring of human attention. As a family, we have done our research. While we don't have a fenced yard, keeping a Corgi would fit into our lifestyle as we are active in walking the neighborhood, routinely visiting parks, and enjoying the outdoors. When my husband first considered welcoming a pet to the family back in 1999, my desire was for a corgi, however our income prevented us from making that a reality. Fortunately, our rescue dog, Nikki, came into our lives and stole our hearts. We had her until November 2014. We are ready to open our hearts again to our next pet. | ||||||
Activities planned with Pembroke: |
Daily walks, 1-2x weekly visits to the dog park (when they open back up here in MI), shower him/her with fun toys, and bring along on family vacations. | ||||||
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? |
No | ||||||
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: |
First, I would determine whether the mistake was due to a physical ailment or poor behavior. If it's behavior related, such as jumping up, I would ignore it by turning away and re-entering the room. I would do this until the jumping up has ceased. As humans, we would wouldn't make entries a big deal, to also not encourage the behavior. | ||||||
Discipline: |
Positive reinforcement would be our method of "discipline." Using praise, treats, toys, and play would be the carrots on the end of the stick. To interrupt negative behavior, we would use stern voices to distract and then redirect to a positive behavior. | ||||||
Where would Pembroke spend the majority of the time: |
At our home, both inside and outside. | ||||||
Discipline: |
Positive reinforcement would be our method of "discipline." Using praise, treats, toys, and play would be the carrots on the end of the stick. To interrupt negative behavior, we would use stern voices to distract and then redirect to a positive behavior. Where would Pembroke spend the majority of the time: At our home, both inside and outside. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes – when we're not quarantining, I am home most of the day, as I teach fitness classes 2-3 times a week, for one hour at a time. Otherwise I am generally a stay-at-home mom, with kids arriving home around 2:30pm. | ||||||
Where would dog eat? |
In the kitchen, we would have a setup with a doggie dish and water station, located near our dining table. | ||||||
Where would dog sleep: |
On a pet bed (or crate, if needed early on), in my bedroom. | ||||||
Play & exercise: |
We would incorporate our corgi into our daily life. Taking walks 1-2x a day, socializing with our neighbors (they have a 1 yr. yellow lab), both kids (along with my husband and I) playing with him/her using toys and making up games. | ||||||
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: |
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Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
Open yard, which backs to shared woods. Our property is treated for mosquitos and ticks. We have a deck, but no pools or hot tubs. | ||||||
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? |
Tiffany | ||||||
Willing to train children? |
Yes. They have experience with our previous pet, Nikki. | ||||||
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? |
N/A | ||||||
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} |