Date & Referral Source | |||||||
State: | {Applicant State:2} | Date of Application: | 01/08/2022 | 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 | Gender preferred: |
Either a Male or a Female | Color preferred: |
Any color | Activity level: |
Couch Potato, Outgoing, Playful |
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? |
My husband and I. | ||||||
Why do you want a Pembroke? |
My husband and I have had the privilege of raising 4 Pembroke Welsh Corgis beginning in 1996. We laid your last baby on 12/9/21 and are heartbroken and lost. We love this breed! | ||||||
Activities planned with Pembroke: |
Going for walks, playing ball | ||||||
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 have always used a firm “no” and redirected them to the correct behavior. My husband and I most definitely DO NOT believe in hitting the dog in any way! | ||||||
Discipline: |
Positive reinforcement. Using treats and praise for desired behaviors. | ||||||
Where would Pembroke spend the majority of the time: |
At home. We do not crate out dogs. They are free to roam the house if we are not home. | ||||||
Discipline: |
Positive reinforcement. Using treats and praise for desired behaviors. Where would Pembroke spend the majority of the time: At home. We do not crate out dogs. They are free to roam the house if we are not home. |
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House dog or outside dog? |
House dog | ||||||
People at home during the day? |
My husband is self employed so us home frequently throughout the day. My mother lives next door and also likes to wander over during the day to get some snuggle time with her grand dogs. | ||||||
Where would dog eat? |
In the kitchen. | ||||||
Where would dog sleep: |
Our Corgis have tended to sleep in the bedroom on the floor next to the bed. We do often have some in bed snuggle time before turning out the lights but make sure to put the baby back in the floor at that time. We do not want them to jump down from the bed and risk getting hurt. | ||||||
Play & exercise: |
My husband loves to take walks with his corgis. I too enjoy walking with them but I love playing ball more. Have found that Corgis can play ball for hours and I absolutely love their antics when it comes to bringing the ball back. Our last Corgi loved to drop it just out of reach! But with my coaxing would nose poke it over to me. | ||||||
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? |
We have a solid wood fence that is secure and does not have space between the planks to escape. | ||||||
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: |
With my mom living next door, we removed the fence that separated the houses so our dogs could have the entire area of the two yards to roam. Plus they loved to wander over to grandma’s for a treat and some loving when we were home. We do have a pond in the backyard wit Coi fish. Our dogs have always been very entertained by it as they watch the fish and frogs. It is approximately 3 feet deep in the middle but has shallow, gradually descending sides. | ||||||
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? |
Kim | ||||||
Willing to train children? |
We do not have children. | ||||||
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. We truly would not plan to have any other pets. We have always had two corgis together but are now at a point where one is desired. When our first of the last two passed away in January, 2021, we thoroughly enjoyed the time we then had with just one for the next 11 months. | ||||||
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} |