Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 07/15/2020 | 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: |
Any color | Activity level: |
Couch Potato, Outgoing, Playful, Energetic, Very Active |
Other preferences: |
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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? |
me | ||||||
Why do you want a Pembroke? |
I want to adopt a Pembroke Welsh Corgi because I have always wanted a dog that’s energetic and lovable while also being a little bit on the smaller side. I have been doing a lot of research about these dogs and i really do believe that these qualities that i’m looking for fit these dogs nicely. | ||||||
Activities planned with Pembroke: |
I would take them on walks to the lake, the dog park, my parents house in the suburb with a huge yard to run around in. I would cuddle them and make them overall just feel so loved and welcome | ||||||
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 believe disciplining is important but i believe that rewarding for the good behavior is more important so that they know what’s good and what’s bad. I would give treats every time they did something good and discipline when something is bad. | ||||||
Discipline: |
I would use guiding discipline techniques to divert them from doing bad things. I would use noises for instance if the puppy nips at me i would make a high pitched noise in order to replicate the noise they make when they get hurt so they know that they’ve caused me pain, and lastly i would use time out. Corgis are very sociable and outgoing and they’ll know that they’ve done something wrong if they’re isolated | ||||||
Where would Pembroke spend the majority of the time: |
Most days the Pembroke will be with me and doing whatever i’m doing. But on days that i’m working it would either be at my apartment on my bed or in doggy daycare socializing with other pups | ||||||
Discipline: |
I would use guiding discipline techniques to divert them from doing bad things. I would use noises for instance if the puppy nips at me i would make a high pitched noise in order to replicate the noise they make when they get hurt so they know that they’ve caused me pain, and lastly i would use time out. Corgis are very sociable and outgoing and they’ll know that they’ve done something wrong if they’re isolated Where would Pembroke spend the majority of the time: Most days the Pembroke will be with me and doing whatever i’m doing. But on days that i’m working it would either be at my apartment on my bed or in doggy daycare socializing with other pups |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
No | ||||||
Where would dog eat? |
in the kitchen | ||||||
Where would dog sleep: |
in my bed or on their bed | ||||||
Play & exercise: |
I will enroll the dog in doggy daycare for the days where I am busy and the days that I am not the corgi will be going on walks with me, to the dog park with me, or running errands with me. | ||||||
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: |
I have a rooftop yard | ||||||
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? |
Hannah Parisella | ||||||
Willing to train children? |
I don’t have a child | ||||||
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} |