Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 04/17/2021 | 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: |
Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Energetic, Very Active |
Other preferences: |
We have 3 female dogs in the home. 1 corgi/beagle (13 years old) Penny 2 female labs. Josie 11 years old Bonnie 4 years old |
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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? |
For us. | ||||||
Why do you want a Pembroke? |
I love their spunk, their little attitudes. They are usually pretty funny souls. We have one, Penny, I found her at 6 months old at a local shelter. She was our love at first sight, I wasn't even there to adopt, I was there to see what items they needed from the store. | ||||||
Activities planned with Pembroke: |
We do everything with our dogs, we never had children, so they are our kiddos. Camping, hiking, boating. We have 4 acres, but a section is fenced in for the dogs in the back yard. We do take them out front or in the fields to run and play. | ||||||
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: |
We tell them "no, no" | ||||||
Discipline: |
We use a stern voice, tell them no. | ||||||
Where would Pembroke spend the majority of the time: |
In our home, with the other dogs. Always with us. If the new addition likes or needs to be in a crate while we are not home that is usually how we start out with the new additions, until everyone is safe and comfortable in the home. | ||||||
Discipline: |
We use a stern voice, tell them no. Where would Pembroke spend the majority of the time: In our home, with the other dogs. Always with us. If the new addition likes or needs to be in a crate while we are not home that is usually how we start out with the new additions, until everyone is safe and comfortable in the home. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
No, we both work outside of the home. But, we do make sure one of us comes straight home to take care of the babies. | ||||||
Where would dog eat? |
Each dog eats in a certain spot, not by each other. 2 eat in the kitchen, one eats in the dining room. He or she would most likely eat in the dining room as well. | ||||||
Where would dog sleep: |
Hopefully in our bed! 🙂 Crate if he or she wants. It's really what the dog needs from us to feel safe. | ||||||
Play & exercise: |
Everyday! The girls run and play all evening after work until they are pooped out and are ready to cuddle up and watch tv. | ||||||
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? |
It has metal posts with metal fencing. We live in the country so we went with a country looking fence. The fencing is squares, I think the call it sheep and goat fencing. | ||||||
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 live in the country. We have 4 acres, the area behind our house is fenced in for the dogs. It is where they go potty most of the time, run around crazy and play. We only take them out front with us under supervision. During nice weather that is every evening, and then we hang out together on the deck. | ||||||
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? |
Holly, but we both have certain responsibilities we take care of | ||||||
Willing to train children? |
No kids | ||||||
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 | ||||||
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} |