Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 11/08/2020 | Referred by: | Other | ||
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, Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Energetic |
Other preferences: |
Good with cats | ||||||
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? |
Family, Grant grew up with dogs and misses them | ||||||
Why do you want a Pembroke? |
I love their giant ears and their tails (both docked and not docked, but I don't condone docking unless medically deemed necessary). They're typically very friendly creatures and we want the energy a Pembroke brings to the family. We follow several Pembrokes on special media, and constantly follow more. Corgis are adorable, and if given the chance to adopt one, we would borrow library reference books. | ||||||
Activities planned with Pembroke: |
Daily walks, trips to the local dog park, fetch in the backyard, | ||||||
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: |
Depending the mistake, example: pees in the house, understand that dogs have accidents, and redirect them outside. Utilize pee mats until the Pembroke is trained for outside. | ||||||
Discipline: |
A firm no, physical containment if absolutely necessary (like holding the canine by the collar to prevent escapage) | ||||||
Where would Pembroke spend the majority of the time: |
Probably on the bed or on the couch. Otherwise, at our side during whatever activity is occurring | ||||||
Discipline: |
A firm no, physical containment if absolutely necessary (like holding the canine by the collar to prevent escapage) Where would Pembroke spend the majority of the time: Probably on the bed or on the couch. Otherwise, at our side during whatever activity is occurring |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes. | ||||||
Where would dog eat? |
Probably the kitchen or dining room | ||||||
Where would dog sleep: |
On a designated dog bed (but if that gets rejected because he likes sleeping on the bed, that is okay too) | ||||||
Play & exercise: |
Daily walks, puppy play dates (other family members not in household own dogs), trips to the dog park & puppy pool | ||||||
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? |
All of our neighbors have fences, so by proxy our yard is fenced in. One side is a chain link fence, the other two sides are wooden fences. | ||||||
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: |
|||||||
Landlord permission: |
|||||||
Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
Fenced in by the neighbors properties. There is a medium sized backyard with a garage. | ||||||
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? |
Grant & Tianna | ||||||
Willing to train children? |
Yes, we are | ||||||
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? |
No, some of our current pets are not friendly toward dogs | ||||||
Are you willing to work on it if your new dog doesn’t get along with your current pets right away? |
We are currently unaware how the cats will react to a canine. We are willing to train and work with all the animals to get alone civilly. There is also enough space in the house for the animals to give each other space | ||||||
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} |