Medd's Original Bullies Application

Perspective Pet Parent*

First NameLast Name

Name of Pet You Wish to Adopt*

Email Address*

example@example.com

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you own any pets?*

Pet Name(s)

Pet Breed(s)

Pet's disposition and behavior towards other dogs?

Please provide your veterinarian's name and phone number:

Do you own or rent your home?*

OwnRent

Do you have a yard?*

YesNo

If "Yes" to the above, is it fenced? please describe

What is your landlord's pet policy?*

If you rent, please provide your landlord's information here:*

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?*

YesNo

Are there children in the home? (If yes, please list ages)*

How many hours per day would the pet be alone?*

Will you crate your pet?*

If you have to leave town, emergently or planned, where would your pet stay?*

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?*

Please provide the names, emails, and contact numbers for 3 personal references:*

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo

If you answered "Yes" please provide a detailed description:

What are you looking for in a dog

Show potenialPetBreeding rights

Are you looking for a male or female? Please note preferred gender may not be available

MaleFemale

By clicking the submit button, I understand Medd's Original Bullies will check my references including veterinary and personal. By clicking submit I understand there is no "cooling off" period, and that if I no longer want or can no longer care for my pet I will notify BY EMAIL and provide a 14 day period to allow Medd's Original Bullies to make arrangents for my pet to be taken back. Refund will not be provided. By clicking the submit button, I agree to indemnify and hold harmless Medd's Original Bullies against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my pet, once sale has been completed. By clicking the submit button, I understand that Medd's Original Bullies will disclose any of the pet's health or behavior issues known by the above named kennel group before sale is completed.

By clicking the submit button, I verify all of the above information is true and accurate.

Signature of Potential Pet Parent*

Placement Application