Application Form

Name:

Full mailing address: Street:

City, State, and Zip Code:

Phone Number:

Email Address

Who are the people your dog will live with? Please list names and ages:

Any family members with allergies? Any family members with allergies? Yes No

Do all family members agree a dog/pup is a welcome addition to the family? Do all family members agree a dog/pup is a welcome addition to the family? Yes No

Who are the pets you currently own? Please list name, age, species and breed.

Have you or any family member ever surrendered a pet to a shelter or breed rescue organization? Have you or any family member ever surrendered a pet to a shelter or breed rescue organization? Yes No

What are your goals/expectations for your new dog?

Do you want a pet who will be spayed/neutered or one that may compete, work and/or breed? Do you want a pet who will be spayed/neutered or one that may compete, work and/or breed? Spay/Neuter Compete/Work/Breed

What age, sex and color do you prefer? Are there other physical attributes you prefer?

What type of exercise/training/socialization will your dog receive

How much time can you devote to your dog?

Is your yard fenced? Is your yard fenced? Yes No

Type of fencing? Height?

May we contact references? Please list your vet and two personal references. May we contact references? Please list your vet and two personal references. Yes No

Veterinarian:

Reference One:

Reference Two: