Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 08/14/2021 | 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: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Outgoing, Quiet, Playful, Energetic, Very Active |
Other preferences: |
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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 me. I am single woman looking for a lovable 4-legged companion. It has been a few years since I owned a dog and am ready again. In the past, my family and I had German Shepherds and a Bernese Mt. dog. We did live in a more rural area, conducive for a larger dog lifestyle. My children are grown and out of the house. Since then I moved into a condominium surrounded by many parks, perfect places to walk and enjoy the outside with a new companion. I do work out of the home which allows for an easier transition time when introducing a Pembroke into my life. | ||||||
Why do you want a Pembroke? |
The Pembroke is an absolutely beautiful dog. Their hair color options are gorgeous and the stature of the dog is magnificent. Their personality is fun and loving. Since they were a "working dog", they do enjoy activity which matches with my lifestyle. I am a very active person and enjoy the outside for a walk or jog. I did read that Corgis are cuddly dogs, perfect, and that they are intelligent dogs ! Since I now live in a condo and in the past had a large breed dog, the Corgi is the perfect fit for my love of the larger breeds (German Shepherd and Bernese Mt. dog) and the longer coat hair. | ||||||
Activities planned with Pembroke: |
Go to the park Walk/ slow jog Play fetch with a frisbee or ball Obedience class Introduce to a friend's dog for "playdate" give lots of love |
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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? |
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: |
First of all, ensure that my dog has enough exercise. Often if the dog is exercised appropriately, many "mistakes" are fixed or aren't there to being with. If a mistake happens (1) use loud noise such as a high pitched yell or a can of coins (2) ignore the dog (3) actually giving the dog a time out. | ||||||
Discipline: |
Positive reinforcement Consistency***** Redirect bad behavior (use a distraction ie loud noise) Crate train |
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Where would Pembroke spend the majority of the time: |
Time spent= my home and outside for exercise and potty breaks. | ||||||
Discipline: |
Positive reinforcement Consistency***** Redirect bad behavior (use a distraction ie loud noise) Crate train Where would Pembroke spend the majority of the time: Time spent= my home and outside for exercise and potty breaks. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes, me. | ||||||
Where would dog eat? |
kitchen area | ||||||
Where would dog sleep: |
Crate or dog bed in my room | ||||||
Play & exercise: |
I have several parks surrounding my condo. Or, a short drive and talk him/her for a walk on a walking trail. He/She will get as much exercise and play as needed. | ||||||
How will you exercise your dog? |
On leash | ||||||
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? |
No, the condo covenants do not prevent me from having a dog. | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
NA | ||||||
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? |
Natalie | ||||||
Willing to train children? |
Yes, but my children are grown and no grandchildren. | ||||||
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 | ||||||
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} |