Please
complete the following information to assist the Ohio Valley Pembroke Welsh
Corgi Club Rescue Committee in attempting to select a suitable Pembroke for you
and your family to adopt. This information will be helpful in determining that a
proposed adoption is in the best interests of the Pembroke and you and your
family. In answering these questions feel free to use the backs of pages or to
attach additional pages.
Your
Name(s)
_____________________________________________
Date _____________
Street
address, City, St. & Zip -
____________________________________________________________________________
Home
Phone _____________
Cell/Work#______________ Email
____________________
Occupation(s)
a. ___________b____________
Own
your home or rent ______ If renting, landlord contact is
______________________
Describe
ideal Pembroke’s approximate age
_______
Activity
level (examples couch potato, quiet, playful, energetic, outgoing)
___________________
_____________________________________________________________________________
Would
a Pembroke mix be
acceptable?
Yes _____ No
________
Have
you owned a dog before? Yes
_____ No
_____. If yes please describe each dog that you have had in about the last 20
years and how long you owned it. If you do not still own the dog, please tell
what happened to each.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Do
you have a vet? Yes __No __. If yes please provide name, city, state and phone
number
_____________________________________________________________________________
Typical
yearly veterinary expenses for a dog are about $250. Is this affordable?
_______
Even
if the Pembroke had been previously housebroken, you should expect that it would
not be housebroken, at first, in a new home. This may be temporary or it may
require retraining. Would you be willing to housebreak a Pembroke?
_________
Will
you be willing to train a Pembroke, including obedience classes?
__________
Do
you have a fenced-in yard? _____. If no, will you walk it on leash? _____Allow
it to exercise under close supervision? _________ Put up a fence/pen or
use a tie-out, or what? ________
Dogs
may become destructive when left alone, but there are ways to train them not to
chew or mess in the house when left alone. Are you willing to take the time and
effort to train? _________
Will
you try using a pen or crate or some other means of solving any such problems?
_________
What
are other ways to train “house manners”
________________________________________
Pembrokes
shed heavily about 2 times
per year: combing, grooming, etc. is required. OK?
___
Describe
your living arrangements. Where the Pem would be living?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
A
club representative may visit your home before you adopt a Pembroke and during
or after the adoption process. Is this acceptable to you?
________________
Describe
all of the persons that live at this home. If any children are in your home
please list their ages and interests, too. Let us know the same info if they
often visit and tell us how often that is.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Have
all of these persons agreed to the adoption of a Pembroke?
____________
Who
will be primarily responsible for caring for the
Pembroke?
____________
Are
you willing to educate your children in the humane care of animals?
____________
Are
you sure no one in your household is allergic to dogs?
____________
Describe
all of the pets that currently live at this home. Type? Age? Sex?
Neutered?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Are
these pets generally friendly toward dogs? ______
The
Pembroke may not initially get along with other pets you may own now or in the
future. If there is trouble are you prepared to find ways to solve it?
___________
Our
rescue agreement will require you to take responsibility for the Pembroke for
its entire life. In the event that is not possible or you can no longer care for
it you must agree to return it to the Committee. Is this acceptable?
__________
Do
you understand that there are no guarantees as to the condition, health,
temperament, behavior or personality of the Pembroke? ________
Do
you understand that the Committee or Club makes no representations as to the
condition, health, behavior or personality of the Pembroke?
_________
It
is very important that no one adopt a Pembroke on an impulse. Have you given
this adoption adequate thought? _______________
Have
you considered the possible problems attendant to adopting a Pembroke? What do
you think they will be in your situation?
_______________________________________
_____________________________________
We
welcome and appreciate your interest in providing a good home for a Pembroke.
Please understand that your completion of this application does not guarantee
that a suitable Pembroke will be found for you. Please also understand that
applicants are not placed on a waiting list in the order of the date of
application. Instead, in each case of selecting a home for a Pembroke all
applications will be considered equally. We do this to attempt to select the
most suitable home for that Pembroke in light of its health, personality,
behavior and other factors. We attempt to select the most suitable Pembroke for
the home in light of the answers you have given above.
In
the event that a Pembroke were to be considered for adoption by you, there will
be written agreements between you and the Committee/Club. In the written
agreement, among other things, you would make certain agreements regarding your
care of Pembroke. You would agree that the Pembroke would be returned to the
Committee/Club if you do not abide by the agreements or if you could no longer
take care of the Pembroke.
Please
understand that, while the Committee/Club will have had the Pembroke examined by
a veterinarian, the Committee/Club cannot make any guarantees regarding the
health or physical condition of the Pembroke. Understand too that all expenses
after the adoption (including medical expenses) relating to the Pembroke would
be your responsibility.
The
Pembroke will be spayed or neutered before you would adopt it. There will also
be a $250 donation (or higher amount if you wish) from you to the Club/Committee
to defray expenses relating to rescue efforts prior to your adoption.
Ohio
Valley Pembroke Welsh Corgi Club Rescue Committee would appreciate it, after you
complete this application for Adoption and while awaiting a Pembroke, if you
notify the chairman if you get another dog. Also let us know if you decide that
you no longer wish to adopt a Pembroke.
You
may keep up with club activities & events by going to our website www.ohiovalleycorgi.org.
For
more information contact:
Jean
or Chester
Fordyce
740-335-5307 forfox1@earthlink.net
Robin
Stewart
614-855-4469 SBrinkley1@aol.com
Kathy
Shannon - co
chair
513-965-8873
wyndfal@fuse.net
RETURN
FORM
TO:
NEENA VAN CAMP, Chairman
513-385-4356
NeenaPembroke@juno.com