Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 03/26/2021 | Referred by: | Friend | ||
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, 5 years – 10 years, 10 years + | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Energetic |
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? |
This Pembroke is for Frank Riehl who has been people partner to seven Corgis over the past 20 years. It may be more truthful that this Pembroke is for Ed, Frank's 15 year old Corgi. Frank and Ed have typically had 3-4 Corgi partners in the house at once. My name is Bill and Frank is a dear friend to me and my family (wife, Deb and daughter, Kari.) Frank, Ed, and I spend most of each day together. I mention this because Frank is 77 years old and should this new member of the family outlive Frank he or she would seamlessly transition be part of our family. | ||||||
Why do you want a Pembroke? |
Our Pembrokes have been very affectionate and playful dogs. The cardigans have been somewhat playful and even protective but less affectionate. I love their attentiveness and their own joy for companionship. | ||||||
Activities planned with Pembroke: |
In the house we play games on the floor – they really can get silly. Outside we can walk literally for miles. We have some great trails where we walk in nature. We have a goat farm we visit and all the corgis have had a great time there! | ||||||
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: |
Stop the action if in progress and say a firm but controlled, "No." Redirect the behavior with an appropriate choice. | ||||||
Discipline: |
Most often, positive reinforcement. "Catch them being good," as we teachers say! This not only includes treats but attention as well. | ||||||
Where would Pembroke spend the majority of the time: |
With us, most days at our 4 acre wooded property that has ample space to run. Nights indoors, likely sleeping in the bedroom | ||||||
Discipline: |
Most often, positive reinforcement. "Catch them being good," as we teachers say! This not only includes treats but attention as well. Where would Pembroke spend the majority of the time: With us, most days at our 4 acre wooded property that has ample space to run. Nights indoors, likely sleeping in the bedroom |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes, and the dogs travel with us typically if we are out as we are generally going to another house where they will be with us or to an outdoor activity. | ||||||
Where would dog eat? |
The food bowl is typically in the kitchen. | ||||||
Where would dog sleep: |
Several choices of dog beds. Our last Pembroke usually chose the foot of the bed. | ||||||
Play & exercise: |
All of our houses have large fenced yards. Each day we will walk wither in the neighborhood or on a trail. | ||||||
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? |
4-foot wooden fence with a 4 inch baseplate. | ||||||
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: |
We have several houses. All are large, multi-level houses. We have no swimming pools although two houses have small (less than 18 inches deep) fish ponds. | ||||||
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? |
Bill | ||||||
Willing to train children? |
Yes, but we have no small 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 – all the animals have shared the house with multiple dogs for over a decade. | ||||||
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} |