Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 04/03/2021 | 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: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Outgoing, Playful |
Other preferences: |
We have a large fenced-in yard, and live near a park, so we can walk and play with our dog outdoors regularly. Shyam also works from home, so our dog would be well cared-for during the day. | ||||||
Dog Ownership History | |||||||
Previous dog owner? |
Yes | ||||||
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? |
This corgi would be for our small family of 3. Kathryn grew up with a rescued corgi, and we both love the breed. We lost our own family dog due to old age, after rescuing her 10 years ago. Now, we want to adopt another rescued corgi for our son to grow up with and to complete our family. | ||||||
Why do you want a Pembroke? |
I grew up with a rescued corgi. I loved him because he was sweet, cuddly, friendly, playful, and smart. He had the attitude of a big dog, but was stuck in that adorable little corgi body. He loved doing whatever the family wanted to do, whether laying on the couch or going for long walks. We loved him so much, he really made an impact on us. We know the breed well, and have done research on them as well. | ||||||
Activities planned with Pembroke: |
With our corgi, we would play inside and out, go for long walks, and go for short daytrips as a family. We would also cuddle with him, keep him or her well groomed, and brush out that soft-fuzzy, ever-shedding hair! My husband works from home, so he would be able to hang out with our dog all day, and take him or her out for walks and such. | ||||||
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: |
If our dog were to make a mistake, we would handle it calmly. We would use a stern voice, and say "no." | ||||||
Discipline: |
Our previous dogs rarely needed discipline, other than using a firm tone. Occasionally, we have used a squirt bottle to squirt them with water. | ||||||
Where would Pembroke spend the majority of the time: |
Our dog would spend most of their time in our home with us. | ||||||
Discipline: |
Our previous dogs rarely needed discipline, other than using a firm tone. Occasionally, we have used a squirt bottle to squirt them with water. Where would Pembroke spend the majority of the time: Our dog would spend most of their time in our home with us. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes, my husband works from home during the day. | ||||||
Where would dog eat? |
Our dog would eat in the kitchen. | ||||||
Where would dog sleep: |
Our dog would sleep in a dog bed in the master bedroom or our child's bedroom. | ||||||
Play & exercise: |
Our dog will get lots of play time and plenty of exercise, either in our yard, or with neighborhood walks. He or she would have daily walks, and lots of opportunities to play outside and inside. | ||||||
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? |
We have a chain link fence surrounding our entire yard. | ||||||
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: |
|||||||
Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
We have a large, fenced in yard. Our yard has a small deck and some trees and shrubs, it is pretty open, lots of room to play, no pools, or any other structures. | ||||||
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? |
Kathryn | ||||||
Willing to train children? |
Yes, our son already has experience in how to treat a dog from our previous family dog, as well as his grandparents' dog. | ||||||
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, we definitely work to help any other possible pets in the future get along, although we do not plan on having any 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} |