Dog/Puppy Application

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

What dog/puppy are you interested in?

Driver's License Number

Date of Birth

Occupation/Place of Business

Type of Residence

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

Does everyone in household want to adopt a dog?

I prefer

I prefer a dog that is

This dog needs to get along with

When I'm not home to supervise, my dog will be

I have or am planning for

My ideal dog would be

Behaviors I can't tolerate are

Will you be taking your dog to obedience training?

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