Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 06/18/2020 | 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: |
Either a Male or a Female | Color preferred: |
Red & White, Red Headed Tri, Sable & White | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Energetic |
Other preferences: |
Ideally need a dog that won't bark very much! | ||||||
Dog Ownership History | |||||||
Previous dog owner? |
No | ||||||
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? |
Myself | ||||||
Why do you want a Pembroke? |
The PWCs are adorable and have good dispositions. I have not been around them a lot but I have researched online and they seem like they will fit my needs. I live in a condo and need a dog less than 40 pounds. They are smart and would be good companions. | ||||||
Activities planned with Pembroke: |
Walking, playing in the park, visiting my friends. I hope the dog would be good in the car and can go with me to see friends and family. | ||||||
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: |
I would try to diagnose the problem and if it is something about the environment, I would try to adjust the home or the situation so it doesn't bother the dog. If it is something the dog can learn I would work on training it by rewarding with treats for the correct behavior. |
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Discipline: |
A loud NO with a palm up would be my first approach. Putting the dog in a crate for a while would be another option. I think if you train a dog properly you can learn non-hurtful ways of disciplining it. | ||||||
Where would Pembroke spend the majority of the time: |
With me in my 2-bedroom condo. I would make sure we both get outside for walks! | ||||||
Discipline: |
A loud NO with a palm up would be my first approach. Putting the dog in a crate for a while would be another option. I think if you train a dog properly you can learn non-hurtful ways of disciplining it. Where would Pembroke spend the majority of the time: With me in my 2-bedroom condo. I would make sure we both get outside for walks! |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Just me. | ||||||
Where would dog eat? |
In the kitchen under the table. | ||||||
Where would dog sleep: |
Either in a crate or in a dog bed in my living room. | ||||||
Play & exercise: |
I would make play dates with my friends who also own dogs. I would walk it 3-5 times a day and at least one of the walks would include playing with a ball in the park near my house. I would go to relatives' houses where there are big yards so it can run around more. There are also dog parks near me and I would go there on the weekends after they open up (currently not allowed because of coronavirus). | ||||||
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? |
Yes | ||||||
Description of yard: |
Condo building – 3 stories | ||||||
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? |
Judy Maritato | ||||||
Willing to train children? |
No children but I would definitely want to teach any child about animals! | ||||||
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? |
No other pets | ||||||
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} |