Puppy Application

How did you hear about Desert Oasis Kennels?
Full Name*

First NameLast Name
Age of Owner(s)
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number - Cellular

Area CodePhone Number
Phone Number - Spouse/Other Contact

Area CodePhone Number
Occupation(s)
Do you live in a:
OwnRentLive with ParentsOther
If Renting are large breed dogs accepted?
RuralSuburbanUrban
Busy/NoisyModerate Comings/GoingsQuiet with Occasional Guests
Please List all People Living in the Household (Include ages)*
YesNo
Please List any Pets you have currently and their temperaments.*
MaleFemaleNo Preference
YesNo
Why have you decided on a Chesapeake Bay Retriever?
Family/CompanionShowHunting/Field WorkWorking/TrialsBreedingTherapy
Any additional information.
YesNo
Why not?
YesNoPartial
Vet Reference: Full Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
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 denial of a puppy from Desert Oasis Kennels.

I certify that the above information is correct, and I understand that the information will be verified.
Date

MonthDayYear
Your name*
E-mail
Should be Empty: