Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 08/09/2021 | 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: |
Other (Please describe in the box below.) |
Other preferences: |
|||||||
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? |
Myself | ||||||
Why do you want a Pembroke? |
I've wanted a Corgi dog for almost ten years now and was able to adopt my own when I had Sunny. Before her, I used to date someone with his own Corgi and I feel as though I raised her for nearly 3 years since I groomed and trained her. They're a great breed that love to listen and play. I've spent a lot of time reading and watching videos on Corgis, but I do not claim to be an expert by any means. I understand this breed can come with its share of back and hip problems if not careful. | ||||||
Activities planned with Pembroke: |
Walks to the park (we are about 4 blocks from a big enclosed park and 2 blocks from the 606, a walk/bike path in the middle of Chicago), teaching tricks (fetch, roll over) | ||||||
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? |
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: |
Ignore it and try to rely on positive reinforcement training to encourage good behaviors. If it's something I could have prevented (putting socks on the floor away, keeping up with a potty schedule), then I try to do better to set them up for success. | ||||||
Discipline: |
I will tell the dog no and push them away if needed, but never hit or yell. The dog doesn't understand violent discipline and will only learn to be fearful. | ||||||
Where would Pembroke spend the majority of the time: |
In the home, the yard, or on walks. We are currently fully remote, so we have the time and space to engage with our dogs. | ||||||
Discipline: |
I will tell the dog no and push them away if needed, but never hit or yell. The dog doesn't understand violent discipline and will only learn to be fearful. Where would Pembroke spend the majority of the time: In the home, the yard, or on walks. We are currently fully remote, so we have the time and space to engage with our dogs. |
||||||
House dog or outside dog? |
House dog | ||||||
People at home during the day? |
My boyfriend who lives with me. | ||||||
Where would dog eat? |
Separately from the other dogs in the kitchen until there seems to be zero food aggression. | ||||||
Where would dog sleep: |
In their own crate. Our Corgi and Husky also sleep in their own crates with the doors open, but we have a few beds laying around the bedroom and living room if they prefer. | ||||||
Play & exercise: |
We have PLENTY of varieties of toys and a yard for them to run around in. Occasionally I have Kongs, lick mats, and kibble puzzles for our dogs to work their brain. Since we are working from home, it's probably at least 2 or 3 hours each day the dogs get to play and exercise. | ||||||
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's a wood picket fence (maybe 7 ft high) on one side, a brick building on the other, and a metal panel fence blocking off the alley. | ||||||
Living arrangements: |
Rent/lease 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? |
|||||||
Lease allow dogs: |
Yes, my lease permits dogs. | ||||||
Landlord permission: |
Yes, my landlord is fine with me owning a Pembroke | ||||||
Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
First floor apartment with a yard, not a house. N/A | ||||||
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? |
Bernice | ||||||
Willing to train children? |
I don't have a child, but absolutely. | ||||||
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} |