Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 03/17/2021 | 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: |
0 months – 1 year (we rarely get dogs in this age group), 1 year – 3 years, 3 years – 5 years, 5 years – 10 years, Any age | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Energetic, Very Active |
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? |
We would love to have a Pembroke join my small “family” to join me, my partner and our adopted pet, Minnie. Minnie is adopted and originally from Texas and this is her first year in Minnesota. Minnie and I are very active and we (especially Minnie) love to play and go on adventures. | ||||||
Why do you want a Pembroke? |
Minnie is about 38-40 lbs and loves to play, especially with other dogs. She loves to interact with others. Of the times She’s interacted with other dogs, the corgis that we’ve meet have meet her have played so well with her. I think some of the pembroke personalities keep her in check which I think is needed for Minnie sometimes when she’s too excited. In addition, I’m so surprised at how well they’ve hold their own at dog parks and with dogs who are bigger then they are in size! | ||||||
Activities planned with Pembroke: |
I’d love to go on daily walks and go hiking when weather permits. We currently do some light jogging and welcome any pembrokes that enjoy jogging. I have a fenced backyard and would get free reign of the yard under supervision. I’d love to train and teach them new tricks. I’d love to do some specialized trainings such as scent or rally-o. I currently work from home and love that I can train, cuddle and bond with my dog and any future Pembroke’s/ dogs to join our team. |
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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 |
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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: |
I would correct their behavior if they made mistakes or were exhibiting bad behaviors. I would not reprehend them for their mistakes. I would encourage them to correct themselves – for example not jumping on people when excited, accidentally knocking something off, etc. | ||||||
Discipline: |
I support positive reinforcement and I DO NOT SUPPORT PHYSICAL ABUSE when discipling. I work on impulse control trainings regularly and would train to leave it, stay and heel. Of the dog shows behavior of regression in training, I’d work on training again. | ||||||
Where would Pembroke spend the majority of the time: |
I work from home and the office; with preference to home. My dog would have free reign of the house when house training is complete. That includes living room, kennel room, and basement. My dog does have access to their own beds and to the comfy sofas. I do have a yard and would encourage my dog to take frequent potty trips and play time outside. My dogs are not outside dogs and I do not leave them outside for most of their time. They would be a house dog. |
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Discipline: |
I support positive reinforcement and I DO NOT SUPPORT PHYSICAL ABUSE when discipling. I work on impulse control trainings regularly and would train to leave it, stay and heel. Of the dog shows behavior of regression in training, I’d work on training again. Where would Pembroke spend the majority of the time: I work from home and the office; with preference to home. My dog would have free reign of the house when house training is complete. That includes living room, kennel room, and basement. My dog does have access to their own beds and to the comfy sofas. I do have a yard and would encourage my dog to take frequent potty trips and play time outside. My dogs are not outside dogs and I do not leave them outside for most of their time. They would be a house dog. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes. I mai my work from home. | ||||||
Where would dog eat? |
In their designated space in the kitchen or living room. If they need to be kennel trained, could be in the kennel temporarily. | ||||||
Where would dog sleep: |
They would get their own bed or sleep on the sofa. While I love to cuddle and nap with them on the sofa, I like to keep my bed dog free (for now). My Dogs are house pets so will not sleep outside. | ||||||
Play & exercise: |
At least two 30 minute plus walks a day. Multiple play times throughout the day to play outside with toys. In addition, I live close to multiple dog parks. | ||||||
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? |
My whole backyard is fenced in. My fence is made of chain links and does not have any holes or gaps below or in the chain. My fence is about 4 ft high and have not had any issues with dogs escaping. | ||||||
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 do not have any swimming pools or bodies of water. My yard is enclosed by fencing. I have a few bushes and a tree that help with landscaping and shade. For the most part it’s pretty open and bare for lots of space for dogs to play. | ||||||
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? |
mailee moua | ||||||
Willing to train children? |
I don’t have any children but I will train my dogs to be children tolerant. If they are afraid of children, I will not force them to interact with children. | ||||||
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 I am willing to train and work on that. | ||||||
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} |