Last Litter Program Application- Dogs

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

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

Are you the legal owner of the Mother dog? If not who is?

Dog's Name

Age and Breed of Dog

If known how many previous litters has your dog had?

Has your dog been:

Has your dog ever been to the vet before? If so when and what for?

Mother's Temperament (please tick all that applies)

How old are the puppies

How many puppies are in the litter?

Where are the puppies kept?

Puppies Temperament (please tick all that applies)

Do you own the father of the puppies? If so, what breed is he?

Is there anything further that you would like to add:

By submitting this application you are agreeing to the following terms and conditions:

I understand this application does not mean acceptance to the Last Litter Program.
I declare the cat is owned by me and I have the legal authority to surrender the litter to Ollie's Legacy Incorporated.
I agree to surrender the entire litter to Ollie's Legacy Incorporated.
I understand that as part of acceptance into this program the kittens must be of good health, temperament and able to handled.
I understand that the mother cat must be desexed at a veterinary clinic nominated and paid for by Ollie’s Legacy Incorporated within 4-6 weeks of weaning her kittens.
I understand that if the application is successful it forms part of the Last Litter Program Agreement.

Signature

Last Litter Program