Whissler Shih Tzu
Puppy Application
please fill out the following form so we can learn a bit about you!
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Cell Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Age of person applying
ex 23 years old
what is your occupation?
i.e. teacher
Second name of person applying for a puppy (if applicable)
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
age of second person applying (if applicable)
i.e. 30 years old
what is their occupation?
i.e. nurse
Life Style and Environment:
activity level
Please Select
Low-couch potato
Moderate-Happy Go lucky
High-climb a mountain every weekend
how active are you with your lifestyle
please elaborate on the type of activities you and/or your family does:
I am looking for a puppy to be:
Please Select
House Pet
Performance pet-(obedience, Rally O, and/or agility)
Therapy dog
other
I am looking for (age group):
Please Select
puppy (under a year)
adolescent (1 to 2 years)
Adult
Senior
gender:
Please Select
male
female
no preference
color preference:
does anyone in your household have allergies:
Please Select
yes
no
if you do have allergies please tell us a bit about that and how you manage your symptoms:
have you owned a dog before?
Please Select
yes
no
do you have any pets currently?
Please Select
no
dog
cat
other
if yes please tell us about your other pet(s):
have you owned a Shih Tzu before?
Please Select
yes
no
if yes, please tell us a bit about your other Shih Tzu and experience with them:
do you have children under 18 years of age in your home?
Please Select
yes
no
if yes please tell us their ages:
do you own or rent your home?
Please Select
own
rent
do you have a fenced yard
Please Select
yes
no
partially
will the puppy live in your home?
Please Select
yes
no
of no, please indicate where the puppy will be living? (kennel, garage, basement)
do you work outside of the home?
Please Select
yes
no
on average how many hours will you plan to leave your puppy alone?
do you travel?
Please Select
yes
no
do you plan on taking the puppy with you?
Please Select
yes
no
if no, please tell us what your intention is for the care of your puppy when you travel:
will you be attending obeidence/puppy training classes?
Please Select
yes
no
if you are unable to keep your puppy, will you return the puppy to us for placement?
Please Select
yes
no
do you have a veterinarian?
Please Select
yes
no
if yes, please tell us the name/vet clinic:
please provide us with two references:
1st reference name
First Name
Last Name
how do you know this person?
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
2nd reference
First Name
Last Name
how do you know this person?
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
please let us know anything else you would like us to know:
Submit
Should be Empty: