Halo Shih Tzu Puppy Application Form

Halo's Shih Tzu Application Form
Please make sure that this application is fully completed, including references.
Full Name

First NameLast Name
What is your occupation?
Age
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Cell phone

Area CodePhone Number
Email
example@example.com
Full Name of 2nd person wanting a puppy( if Applicable)

First NameLast Name
What is your occupation?
Age
Home Phone Number of 2nd person

Area CodePhone Number
Cell Phone Number of 2nd person

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Life Style and Enviroment:
This will help us match up the puppy to his/her new family.
Activity level is:
Please elaborate on the type of activities you and/or your family does:
I am looking for a puppy to be a:
I am looking for (age group)
Gender
Color:
Do you or any member of your family have allergies?
Please indicate how you manage your symptoms:
Have you owned a pet before?
If yes, please list what kind of pets did you have?
Do you have pet now?
If yes, what kind do you have:
Do you have children living in your home:
If yes, please tell us their ages:
Do you own your own home?
If no, please submit to us your landlord's information as a reference
Do you have a fenced in yard?
If no, are you planning to fence your yard? Please explain further:
Will the puppy live in your home?
If no, please indicate where the puppy will be living? (Kennel, Basement, Garage ect...)
Do you work outside of the home?
On average, how many hours will the puppy be left alone?
Do you travel?
Do you plan on taking the puppy with you?
If no, please tell us what your intention would be with your puppy's care while you are traveling:
Will the puppy be attending obedience/puppy classes?
If you cannot keep your puppy, will you return the puppy to us for placement?
Do you have a vetenarian?
If yes, please provide us with the name of the Veterinary Clinic/Hospital
Veterinarian's Name:

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Please note, because of the Privacy Act, your vet and their staff are not allowed to speak with us without consent from you. Please make sure to call and give permission to them.
1st Reference:

First NameLast Name
Home Phone #

Area CodePhone Number
2nd Reference:

First NameLast Name
Home Phone #:

Area CodePhone Number
Please let us know anything else we may need to know:
Date Of Interview: ____________________ Approved: Yes No Wait list Placement:___________________
Should be Empty:

Halo's Shih Tzu Application Form

Life Style and Enviroment:

This will help us match up the puppy to his/her new family.

Please note, because of the Privacy Act, your vet and their staff are not allowed to speak with us without consent from you. Please make sure to call and give permission to them.

Date Of Interview: ____________________ Approved: Yes No Wait list Placement:___________________

Date Of Interview: __ Approved: Yes No Wait list Placement:_