Name *
E-mail Address *
Address: *
City: *
State: *
Zip: *
Phone Number: *
Date of Birth: *
Work Number: *
Employer: *
Name / relationship of adults in house: *
Name / Age / Relation of children in the home *
Do you currently own any other dogs? *
Please list name, dog breed, age, and if spayed / neutered
Do you have any other pets besides dogs? *
If so, please list type, age, spay / neuter
Please list any dogs you previously owned, breed, sex, spay / neuter and what happened to them. If they are deceased, please list cause and date. *
Home: *
Own
Rent
Type of Home *
House
Condo
Apartment
Other - please specify
Other - please specify
Landlord's Contact Information, include name, address, and phone number
Do you have a fenced in yard (not kennel) ? *
If you have a fence, what type of fence do you have?
n/a - no fence
4 foot chain link
4 foot wood fence
6 foot stockade fence
If you do not have a fenced in yard, please describe how you plan on exercising the dogs, allowing it to go to the bathroom, etc. Do you plan on using a runner, tie out or kennel?
Where will the dog primarily live? *
Inside
Outside
Where will the dog sleep at night? *
Please describe where will the dog be kept when you are not at home (crate inside, outside in dog house, etc.)? (please provide a complete description) *
What made you decide upon a puppy? *
Will you attend obedience class within 4 weeks of adoption? *
Will you contact us if you have any questions or problems? *
Will you return the puppy to us if you are no longer able to care for him / her? *
Are you looking for a male or female puppy? *
Please add any additional comments / clarifications for the questions and answers from above.
Please name the puppy or dog you are interested in:
Please describe the type of puppy you are looking for, include breed, personality, specific training such as agility, etc. *
Veterinarian Information - please include name, clinic name, address, phone number and the name on the account. Please note the last time that you utilized this clinic. *
Please list three personal references, include relation to you, number of years known, name, phone number, etc. Please note that these people cannot be related to you. *
Please list any additional information you may wish to include. Thank you.