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Full Name

First NameLast Name

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number - Primary

Area CodePhone Number

Phone Number - Alternate

Area CodePhone Number

Do you live in a:

Do you:

If Renting: Please indicate landlord contact information

Household Setting

Describe your Homes Activity Level

Please List all People Living in the Household (Include Name, Relationship, Gender and Age)

Does Anyone in your Household have Allergies to Animals?

If yes to the above, how severe are the allergies

Are all members of your Family agreeable to owning a Dog?

If no to the above, list family members who are not interested in having a puppy/ dog:

Have you ever owned a dog before? if so, what happend to him/ her?

Have you ever relinquished a dog to a shelter or rescue organization? If so, please explain.

Veterinarian Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Gender?

Size of preference?

Coat color preference?

Please list any colors you would not accept:

If you are interested in a specific litter, please specify

If you have children, have they been exposed to dogs?

We cannot guarantee a dog to be housebroken, are you equipped to train with love and patience?

Do you or you and your significant other work outside the home during the week?

Please explain what your plans are for your pet while you are at work or away from home to run errands:

Are you willing to use a crate for a dog if recommended?

Do you have a fenced yard?

If fenced, please give details on height, material, # of gates, are gates locked or lockable?

How many hours in a day will your puppy be left alone?

Do you have a pool, hot tub or water source in the yard that the puppy / dog will be using? Please explain here:

Please explain how you will train your dog to safely be around the water mentioned in the previous question.

What are you plans to exercise your puppy? Please list any parks near by or trails, how many walks a day, approximate length, activities such as agility

Where will your puppy sleep at night?

Do you plan on obedience training with your puppy, such as classes or private trainer?

Are you committed to caring for this puppy / dog for the duration of his/ her life, which could be 14 + years?

Are you aware of the time and energy needed to care for a young puppy, and are you willing to accept the responsibility?

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of my application for a pet puppy.

I certify that the above information is correct, and I understand that the information will be verified.

Date

MonthDayYearHourMinutesAM/PM Option

Your name

Co-Applicant name (if applicable)

Puppy Application