Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 04/04/2021 | 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: |
1 year – 3 years, 3 years – 5 years, 5 years – 10 years | Gender preferred: |
Male, Either a Male or a Female | Color preferred: |
Red & White, Sable & White | Activity level: |
Couch Potato, Outgoing, Quiet, Playful |
Other preferences: |
Semi-Carpeted home, sliding back patio doors, fenced yard, wonderful neighborhood. Plenty of gated fields within 2 blocks. This dog, which ever it may be, will have a wonderful life. I also work closely with Happy Dog Barkery but can provide references. I look forward to hearing from your team soon! | ||||||
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? |
The Corgi would be for me. I had a rescue Rottie for a while who has since crossed the rainbow bridge. I have a small black lab mix and I've been volunteering, fostering, and transporting for CILRA (Centeral Indiana Lab Rescue). I have plenty of references if you'd like to browse them. I'm a dog lover and rescuer through and through. | ||||||
Why do you want a Pembroke? |
I've done research on the breed. I've always wanted a Corgi, they're like a bread load with legs. I would also like a smaller breed dog due to physical limitations. | ||||||
Activities planned with Pembroke: |
Walks, lots of forest preserves near us, guided pet training, giving smooches belly rubs and a whole love of loving. | ||||||
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: |
Show the dog the issue, say " no no that's not nice no", then I'd remedy the mistake | ||||||
Discipline: |
Verbally (not screaming or shouting) tell the dog "that's a no-no" Then I take her out on a run or a walk because misbehavior tends to come from boredom or lack of stimulation. | ||||||
Where would Pembroke spend the majority of the time: |
I work remotely so the dog would be home with me, out and about on a walk, or enjoying the spacious yard. | ||||||
Discipline: |
Verbally (not screaming or shouting) tell the dog "that's a no-no" Then I take her out on a run or a walk because misbehavior tends to come from boredom or lack of stimulation. Where would Pembroke spend the majority of the time: I work remotely so the dog would be home with me, out and about on a walk, or enjoying the spacious yard. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes | ||||||
Where would dog eat? |
Kitchen – I have an inhouse dog feeding area set up | ||||||
Where would dog sleep: |
Share the bed with me, in it's own bed, or if it's crate trained the dog can make that decision. | ||||||
Play & exercise: |
I have a young lab who would love a play partner plus we have so many dog parks, forest preserves, and fenced fields that the dog will be more than satisfied. Dog walks happen 2 – 3 times a day | ||||||
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? |
Standing issue chain link fence | ||||||
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: |
Shed in yard, no pool. Pretty simplistic | ||||||
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? |
Sarina Pekovic | ||||||
Willing to train children? |
No 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. My pets are my children and top priority. | ||||||
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} |