Cactus Heelers

Cactus Heelers

Please fill out this form to apply for adopting a puppy or dog.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
How would you like to be contacted ?
What age are you interested in ?
Are you looking for a Male or Female ?
Do you have a color preference?
Have you ever owned an Australian Cattle Dog?
What activities are you and you puppy/dog going to be involved in?

Other
If "other" please tell me more about the plans you have to keep an active pup/dog busy?
Tell me about the dogs you currently have. Name, breed, sex, age, Is the pet spayed or neutered?
Do you have other pets? if yes please tell me about them.
Tell me a little bit more about yourself and others in your family.
Are you interested in full/breeding rights or limited/pet home
Are you willing to Spay/Neuter
How would you describe you household activity Level?
Where will the puppy/dog live? Where will the dog/puppy stay during the day? Where will the dog/puppy stay during the night?
Do you own your home or rent?
Do you live in:

Other
Do you have a fenced in yard?

Other
Are you acquiring a puppy/dog for yourself or for someone else? if for someone else are they aware of your intentions or is it a surprise?
As a breeder, it is important for me to keep track if all puppies/ dogs that have been placed. Are you willing to work with me to stay in contact regarding the development of your puppy/Dog
Have you ever given a dog away? if so why?
If you were to move, what would happen to your puppy/dog?
In the event of an emergency, who would take care of your dog/puppy?
In the event of an emergency (hospitalization, natural disaster etc) who would take care of your dog/puppy?
Have you or anyone in your household ever been charged with animal cruelty or had any animal taken away from you or a member of your household for suspicion of animal cruelty? If yes please explain.
Do you have any questions, comments, concerns you would like to share with or any other information I should know about?
Should be Empty: