Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 05/12/2021 | 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: |
0 months – 1 year (we rarely get dogs in this age group), 1 year – 3 years | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Outgoing, Playful, Very Active |
Other preferences: |
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Dog Ownership History | |||||||
Previous dog owner? |
No | ||||||
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? |
Me and my family | ||||||
Why do you want a Pembroke? |
I want to an adopt a corgi because it’s been my dream dog since I was little. They are loving, energetic, friendly, and make a good companion. I’ve done plenty of research on corgis so I know how to take proper care of the dog. | ||||||
Activities planned with Pembroke: |
I plan on going on walks and maybe going camping up north once in a while/ | ||||||
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: |
I would use conditioning to make sure he/she stops making the mistake over time. | ||||||
Discipline: |
I won’t be too harsh, but use positive reinforcement with the dog and turn he/she away from poor behavior. | ||||||
Where would Pembroke spend the majority of the time: |
I would spend time taking he/she on walks, going on adventures, or spending time in the house | ||||||
Discipline: |
I won’t be too harsh, but use positive reinforcement with the dog and turn he/she away from poor behavior. Where would Pembroke spend the majority of the time: I would spend time taking he/she on walks, going on adventures, or spending time in the house |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes my grandma will be home all day | ||||||
Where would dog eat? |
In the kitchen. | ||||||
Where would dog sleep: |
In the bedroom where I sleep | ||||||
Play & exercise: |
I will have toys for the corgi so he/she can play. I will bring the corgi on walks everyday and maybe to the dog park once in a while. | ||||||
How will you exercise your dog? |
Both on leash and restrained to the yard | ||||||
Fenced yard? |
No, I don’t have a fenced in yard. | ||||||
Willing to pick up dog waste? |
Yes, I will clean up after my dog. | ||||||
Willing to use a crate? |
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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: |
We have a very open front and back yard for the dog to roam in. There are a couple trees and we go have an outside leash, so the dog will not run off | ||||||
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? |
Amber Cothern | ||||||
Willing to train children? |
We do don’t have any children in the house, only adults. If it does come to that one day, we are willing to teach the children how to take care for animals. | ||||||
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 I am willing to fix the problem | ||||||
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} |