| CONTACT
INFORMATION |
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|
Name * |
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| Address * |
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| City * |
State *
Zip Code *
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| Home Phone * |
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| Cell Phone |
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| eMail * |
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| Marital Status: |
Married |
Single |
| Do you currently
own any dogs? |
Yes |
No |
If so, please list
name, sex, age and spayed/neutered status
of each:
|
|
| If any canine is not sterilized,
give reason |
|
| Did you ever give
up a pet? |
Yes |
No |
| If so, why? |
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| VET
INFORMATION |
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| Vet Name: |
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| Phone: |
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| HOME
INFORMATION |
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| Do you rent or own your home? |
Rent |
Own |
| If rent, does your lease allow
pets? |
Yes |
No |
| If rent, provide landlord name
and phone number |
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| CONTAINMENT INFO |
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| Describe the type of fence that
will contain your canine: (e.g., wood, metal,
block, etc):
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| Fence Height: |
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| Provide either: fence length and
width (in feet); or, total area enclosed by fence
(in square feet): |
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| Are dig guards present? |
Yes |
No |
| Are you willing to build adequate
containment prior to adoption? |
Yes |
No |
| PET INFORMATION |
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| Where Exercised? |
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| Is Family Member Home During Day? |
Yes |
No |
| Who Is Home? |
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| How many hours a day will the
pet be left alone? |
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| JOB INFORMATION |
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| Employer: |
|
| Employer address: |
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| COMMENTS |
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| State briefly why you are interested
in this particular breed |
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