Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 05/02/2021 | 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: |
Any age | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Outgoing, Quiet, Playful, Energetic |
Other preferences: |
WHEN I TRAVEL I WANT TO BE ABLE TO TAKE THE DOG WITH ME IN MY CAR. | ||||||
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? |
MYSELF– HAVE A NICE SIZE FENCED BACK YARD–HAVE 2-RESCUED CATS; ONE ONLY 3-LEGS–HAVE OWNED CORGIS IN THE PAST–JUST MOVED INTO A HOUSE–OLDER AND NOW WORKING JUST PART-TIME | ||||||
Why do you want a Pembroke? |
I HAVE OWNED RESCUED CORGIS IN THE PAST. THEY ARE JUST THE RIGHT SIZE FOR ME. THEY ARE SMART AND DO WELL WHEN TRAINED WITH COMMANDS. ALL MY CORGIS HAVE PLAYED BALL WITH ME IN THE PAST. |
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Activities planned with Pembroke: |
THROW THE BALL WITH RETRIVIAL AGILITY TRAINING TRAIN WITH COMMANDS WALKING |
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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? |
No | ||||||
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: |
CONSISTENT TALKING AND TRAINING TEACH DOG TIME- OUT CORNER SITTING AND STAYING IN PLACE |
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Discipline: |
REFER TO ABOVE STATEMENTS | ||||||
Where would Pembroke spend the majority of the time: |
WITH ME WHILE IN HOUSE OUT-SIDE FENCED IN BACK YARD |
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Discipline: |
REFER TO ABOVE STATEMENTS Where would Pembroke spend the majority of the time: WITH ME WHILE IN HOUSE OUT-SIDE FENCED IN BACK YARD |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
YES, MYSELF DURING THE TIMES MY GRANDSON VISITS MY SON IS IN AND OUT OF MY HOUSE SEVERAL TIMES A WEEK |
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Where would dog eat? |
THE FOOD DISH WOULD BE PUT DOWN ON KITCHEN FLOOR AT APPROPRIATE TIMES. ONCE FINISHED EATING FOOD DISH IS OFF THE FLOOR. WATER DISH IN 2-LOCATIONS; KITCHEN AND LAUNDRY ROOM AT ALL TIMES. |
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Where would dog sleep: |
IF THE DOG WANTED TO SLEEP WITH ME THAT IS FINE. I WILL PROVIDE LARGE DOG BED. |
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Play & exercise: |
MORN AND NIGHT WALKS. DAILY BALL SESSIONS. DOG PARK AFTER INTRODUCED AND ACCOUSTOMED TO PARK AND OTHER DOGS. |
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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? |
6 FT- HIGH WOOD FENCE WITH 2 LOCKED GATES FROM THE INSIDE. ONLY WAY IN AND OUT OF HOUSE TO BACK YARD IS THRU THE LAUNDRY ROOM DOOR. I HAVE PLANS TO INSTALL A DOG-DOOR ONCE ACCLAMATED TO SURROUNDINGS AND I KNOW SUFFICENTLY TRAINED TO USE DOOR |
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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: |
LARGE BACKYARD WITH 6-FT HIGH WOOD FENCE LARGE TREES LARGE DECK SMALL SHED |
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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? |
SELF | ||||||
Willing to train children? |
YES HAVE BEEN TRAINING GRANDSON SINCE VERY YOUNG IN AGE ON HOW TO TREAT ANIMALS |
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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? |
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Are you willing to work on it if your new dog doesn’t get along with your current pets right away? |
YES AGAIN TREAT ANIMALS WITH LOVE AND GUIDANCE AND ALL HUMANS AND ANIMALS LEARN TO GET ALONG WITH EACH OTHER. |
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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} |