Dog/Puppy Application
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.
What dog/puppy are you interested in?
Driver's License Number
Date of Birth
Occupation/Place of Business
Type of Residence
House
Apartment
Own
Rent
Live with Parents
Other
Landlord Contact(if renting)
Do any members of the household have pet allergies?
Who will be assuming responsibility for this dog?
Please list current and past(within past 5years) pets owned(include breed, age, if pet is fixed/vaccinated/still in your care)
Current Veterinarian
I am adopting this dog for
Companion
Gift
Guard Dog
To breed
Does everyone in household want to adopt a dog?
Yes
No
I prefer
Male
Female
Either
I prefer a dog that is
Small
Medium
Large
Any
This dog needs to get along with
Other dogs
Cats
Livestock
Small animals
When I'm not home to supervise, my dog will be
Crated in the home
Outside in yard
Loose in home
In garage
I have or am planning for
Fenced in yard
Tie out
Fenced dog run
Invisible fencing
My ideal dog would be
Behaviors I can't tolerate are
Will you be taking your dog to obedience training?
Yes
No
What provisions will you make for this dog should you be unable to care for it?
How did you hear about us?
Please include one reference. This reference should not be a part of your household.
Any other comments
Submit
Should be Empty: