Application Form
NorCA Panthers
Name
*
First Name
Last Name
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about us?
*
Family
Friends
Online
Other
Who are you buying this dog for?
*
Myself
Family
Other
What is the intended purpose for this dog? (Select all that apply)
*
Working Dog
Family Pet
Training Competitions
Service Dog
Other
Any children at home or visiting
*
Yes
No
How many children at a time?
*
How busy are you and your family's schedule?
*
Very Busy
Busy
Not Busy
Other
How would you describe your personality? (Select all that apply)
*
Loud
Calm
Active
Energetic
Nervous
Quiet
Lazy
Other
What kind of home do you reside in?
*
Residential Home
Appartment/Condo
Acreage
Other
Do you own or rent your property?
*
Own
Rent
On average how many hours will your dog be alone on WEEKDAYS?
*
On average how many hours will your dog be alone on WEEKENDS?
*
Where will your dog stay during the day when alone? (select all that apply)
*
Crated Inside
Fenced Yard
Loose in the House
Dog Run/Kennel
Garage
Other
Where will your dog stay/sleep at night? (select all that apply)
*
Crated Inside
Fenced Yard
Loose in the House
Dog Run/Kennel
Garage
Other
Who will have primary responsibility for this dog?
*
Have you had dogs before?
*
Yes
No
Tell us a little bit about your previous experience with dogs:
*
What will you enjoy doing with your dog(s)?
*
On-leash Walking
Jogging
Off-leash Walking
Dog Parks
Cycling
Other
Are there other pets in the household?
Rows
Name
Species/Breed
Sex
Age
Fixed?
Animal 1
Male
Female
Yes
No
Anima 2
Male
Female
Yes
No
Animal 3
Male
Female
Yes
No
Animal 4
Male
Female
Yes
No
What are you looking for?
Describe to us exactly what you are looking for in a dog?
*
Sex?
*
Please Select
Male
Female
No Prefence
Coat Colour?
*
Black
Chocolate
Fawn/Buckskin
Blue/Seal
No Preference
Age
*
Please Select
Puppy
Adult (between 1-5)
No Preference
Puppies will require training and time:
Rows
Yes
No
Not sure
I am a first time puppy owner
I have obedience trained before
I have potty trained before
I have lots of experience handling puppies and dogs
Potential problems that you are willing to work through with your dog? (select all that apply)
*
Obedience and Socialization
Excitability
Housetraining
Barking
Fearfulness
Reactive to other dogs
Mild Aggression
Seperation Anxiety
I am not willing to work on any of these problems
I need more information to decide
Other
Under what circumstances would you re-home your dog?
*
Moving
Too Costly
New Baby
Medical Reasons
Aggression
Behaviour Problems
Time Commitment
None
Other
I would like my dog to be:
*
Rows
Very Important
Somewhat Important
Not Important
No Preference
Friendly with me
Friendly with children
Friendly with other dogs
Friendly with cats and other small species
Friendly with visitors
Enjoy being groomed
Enjoy being petted
Enjoys lounging with owner
Calm
Playful
Quiet
Independent
Toy driven
Never shows unnecessary aggression
Have you ever been convicted or accused of animal cruelty or neglect?
*
Please Select
Yes (Please Specify)
No
If "Yes" please specify:
Are you willing to have a member of the NorCA Canis Panthers Team view your home, visually or electronically?
*
Please Select
Yes
No
I understand that this application form is a required form in which the NorCA Canis Panthers Team uses to gather more information about a buyer and will be used as a tool when accurately matching puppies to their future homes. This form is not an exact guarantee of the puppy you may receive and guarantees no promises of the sale of an animal.
*
I Understand
The applicant verifies that everything stated above is accurate and honest. Falsified information will lead to automatic rejection of the application. NorCA Canis Panthers reserves the right to refuse any applicant.
*
I Do
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