| Date & Referral Source | |||||||
| State: | {Applicant State:2} | Date of Application: | 09/20/2020 | 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: |
1 year – 3 years, 3 years – 5 years | Gender preferred: |
Female, Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Playful |
Other preferences: |
We live in an apartment, so the ideal fit would be a corgi who enjoys walks and playtime but also loves cuddling on the couch and napping. | ||||||
| Dog Ownership History | |||||||
Previous dog owner? |
No | ||||||
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? |
For both of us but primarily as a companion animal for me, Alexa. | ||||||
Why do you want a Pembroke? |
My first dog with my family was a Pembroke! I love their stubborn attitudes and quirky mannerisms. Their herding mentality cracks me up – my Pembroke would herd kleenex if they were left on the coffee table. She'd build a small stash by her water bowl. Never ate them, but loved collecting them. | ||||||
Activities planned with Pembroke: |
Walks! Playing in the snow! Lots of fun toys for indoor playtime and toys for going to the park! Swimming in a clean lake or pool if they enjoy swimming. Lots of cuddling of course! |
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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 |
||||||
|
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: |
Redirection. Giving them something else to focus on instead of continuing the behavior. Taking them to a different room if they won't redirect and continuing that pattern until they understand the behavior isn't good. | ||||||
Discipline: |
Firm voice and time-out. Like kids, it works to send your misbehaving fur-child to their kennel or bed to calm down. A firm "no" and reward for desired behavior works wonders. |
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Where would Pembroke spend the majority of the time: |
In the house | ||||||
Discipline: |
Firm voice and time-out. Like kids, it works to send your misbehaving fur-child to their kennel or bed to calm down. A firm "no" and reward for desired behavior works wonders. Where would Pembroke spend the majority of the time: In the house |
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|
House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes. Braeden works evening a night shift and I work a day shift so there will only be a couple hours where our dog would be by themselves. | ||||||
Where would dog eat? |
In the kitchen next to our entryway closet. | ||||||
Where would dog sleep: |
Either in their kennel in the living, in my room with a their own bed, or with me in my bed. | ||||||
Play & exercise: |
Walks every day with alternating routes – around neighborhoods, trails, and parks. Play in the dog park if they're comfortable with it, otherwise play outside in a non-dog park with toys. | ||||||
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: |
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: |
Yes, my landlord is fine with me owning a Pembroke | ||||||
Restrictive covenants? |
No, the condo covenants do not prevent me from having a dog. | ||||||
Breed/size restrictions? |
No | ||||||
|
Description of yard: |
n/a | ||||||
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? |
Alexa Workman | ||||||
Willing to train children? |
In the future if I chose to have children, yes. | ||||||
|
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? |
Yes, the contingency of getting another pet will be if the corgi does/doesn't do well with 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} | ||||||