Guardianship Application Form

Full Name(s)*

First NameLast Name

Are you above the age of 18?*

YesNo

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number - Primary*

Area CodePhone Number

Phone Number - Secondary

Area CodePhone Number

Do you live in a:*

Do you:*

OwnRentLive with ParentsOther

If Renting: Please indicate landlord contact information

Household Setting*

RuralSuburbanUrban

Describe your Homes Activity Level*

Very ActiveModerately ActiveQuiet with Occasional Activity

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

Does Anyone in your Household have Allergies to Animals?*

YesNo

Are all members of your family agreeable to adopting a dog ?*

YesNo

Please list any pets you have currently living in your home (include breed, sex, spayed/neutered, age, temperament)*

Do you have a preference on the of sex the guardianship dog?*

MaleFemaleNo Preference

Are you willing to become a guardian to a dog of any age?*

YesNo

If not, what age would you consider?

Have you ever owned a Labrador before?*

YesNoNo, but I have owned other breeds

Please describe the type of dog(s) you have owned in the past (Please include breed, personality traits, energy level, sex, if altered or intact, and any sports or activities you did with them). *

Most of our guardianship dogs are female and undergo a heat cycle every 6 months. Have you experienced a female dog in heat before?*

YesNo

If placed with a female dog, do you agree to care for the dog during its heat cycle in a manor deemed acceptable by the breeder?*

YesNo

Do you drive or have access to a vehicle to bring your guardian dog to vet appointments or the breeder?*

YesNo

If No please explain

Are you willing to follow the breeders guidelines in terms of veterinary care? *

YesNo

Do you agree to feed the recommended food agreed upon by the breeder and veterinarian?*

YesNo

Do you understand that you will be responsible for all costs associated with any accidents or illnesses that arise while the dog is in your care, excluding those related to breeding?*

YesNo

Do you agree to maintain the dogs training including obedience, crate training and potty training?*

YesNo

Do you agree to keep the dog at a healthy weight as determined by the breeder and veterinarian?*

YesNo

Do you understand that your dog will live with the breeder while being bred, pregnant and during nursing?*

YesNo

Do you have a fenced yard?*

YesNoPartial

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

How many hours in a day would the dog be left alone?*

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

Do you have experience hunting with labradors or other bird dogs? If yes, please explain your experience and your plans with the guardian dog. *

Please list 1 veterinary reference and 2 personal references with names, addresses, phone numbers and how related. We prefer it not to be all relatives. Are you ok with this?*

YesNo

Vet Reference: Dr.*

First NameLast Name

Name of veterinary clinic*

Phone Number*

Area CodePhone Number

Reference #1: Full Name*

First NameLast Name

Relation to applicant(s):*

E-mail*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

Reference #2: Full Name*

First NameLast Name

Relation to applicant(s): *

E-mail*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

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 any North Legacy Labrador adopted by me. I certify that the above information is correct, and I understand that the information will be verified. I understand that by submitting this form electronically, I agree to release and covenant to hold harmless North Legacy Labradors and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the dog. I accept full responsibility for the dog(s) actions at all times, and release North Legacy Labradors from any liabilities or damages that may be incurred because of adopting such dog(s). I agree to have North Legacy Labradors complete reference call checks to be able to approve my application.

Date

MonthDayYear

Your name*

E-mail