Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 11/17/2021 | Referred by: | Other | ||
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: |
Must be okay with a cat. | ||||||
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? |
Our family! We have two kids age 15 & 17. We also have a cat. | ||||||
Why do you want a Pembroke? |
We have been dreaming of getting a corgi again for a few years. We are finally at a spot where we can be a forever home for one. (We are done moving around) We had a tri color pembroke welsh corgi when our kids were small. We had to rehome him when we moved overseas for a few years. It absolutely broke our hearts. We are excited to be on the other end this time as the forever home. All of us are ready to love on another corgi. | ||||||
Activities planned with Pembroke: |
We plan to include it in every possible activity we can! Starting with lots of walks. We live in a neighborhood where everyone loves to walk and most have dogs. At the end of the day we hope they will like to cuddle as we unwind from the day. | ||||||
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 correction. Preferably when they are caught in the “act” with consistent correction words. Then followed with positive reinforcement when good behavior is displayed. Being attentive is helpful when training. | ||||||
Discipline: |
Verbal and consistency. One example: I have held a dogs nose to a mistake and sternly said “no.” Or help them sit when training not to jump on guests. Repetition and consistency are necessary. | ||||||
Where would Pembroke spend the majority of the time: |
With me! I work from home and am rarely gone all day. | ||||||
Discipline: |
Verbal and consistency. One example: I have held a dogs nose to a mistake and sternly said “no.” Or help them sit when training not to jump on guests. Repetition and consistency are necessary. Where would Pembroke spend the majority of the time: With me! I work from home and am rarely gone all day. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
Yes, I am usually home. And I would bring them with me when I do have to go out. | ||||||
Where would dog eat? |
It’s been a while since I looked for good quality dog food. We don’t feed dogs scraps directly from the table. But will probably give a healthy people food snack occasionally. | ||||||
Where would dog sleep: |
That would probably depend on the dogs preference. We are open to anything from crate trained to a dog bed. However I know we might eventually end up letting them snuggle in bed with one of us occasionally. | ||||||
Play & exercise: |
Lots of walks! As I mentioned before our neighborhood is full of people walking and most have dogs. I would love to have my own corgi join me on daily walks or more often. | ||||||
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: |
|||||||
Restrictive covenants? |
Not applicable | ||||||
Breed/size restrictions? |
No | ||||||
Description of yard: |
We own a large duplex and live in the lower. We have about 1500+ sq ft of living space. We have a backyard and driveway space. It is not completely fenced in. Only partially. Our neighbor keeps their corgi/golden retriever mix on a long leash when they aren’t outside. | ||||||
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? |
Me, Angela | ||||||
Willing to train children? |
Yep, we have really awesome kids who are respectful and responsible. I don’t want to brag, but they are growing up to be great people. | ||||||
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 also open to any advice or tips on introducing them, etc. | ||||||
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, [email protected], friend.:87} |