Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gender: *

Male

Female

Either

What age range are you looking for: *

8wks - 6 months

6 months -12 months

12 months and older

What temperament are you looking for: *

Companion

Therapy

Service

Does anyone in your household have allergies or asthma? *

Yes

No

Does anyone in your household have a disability? *

Yes

No

Age range of adults in home: *

(check all that apply)

21 - 29

30 - 39

40 - 49

50 - 59

60 - 69

70 - 79

80+

Are they any children in your home? *

Yes

No

Do you have any other pets? *

Yes

No

Have you ever had a dog? *

Yes

No

Do you: *

Own

Rent

Other

Are there any restrictions or covenants pertaining to dog ownership where you live? *

Yes

No

How will you plan on containing your dog/puppy? *

Traditional Fence

Invisible Fence

Tie-Out

Other

What sort of lifestyle do you live? *

Active

Semi-Active

Sedentary

Do you plan on using a crate with your puppy? *

Yes

No

Do you have a current vet? *

Yes

No

Can we contact your vet? *

Yes

No

Are you aware that a puppy/dog takes a lot of work and consistency? *

Yes

No

Will the cost of caring for a new puppy fit into your budget? *

Yes

No

Are you committed to caring for this dog for his/her lifetime? *

Yes

No

Do you agree to provide your puppy/dog with all necessary veterinary care to maintain good health? *

Yes

No

Do you agree to contact us if you are no longer able to care for this puppy/dog so that we can assist you in rehoming him or her? *

Yes

No

Do you agree to never relinquish this puppy/dog to a shelter? *

Yes

No

Do you understand that a puppy/dog is a lifetime commitment. You are committing to your dog for the length of its life, this can be up to 15 years. Are you ready for that commitment? *

Yes

No

It is important to maintain your dog’s health and its training during that time. A healthy well-behaved dog is a happy dog. Do you commit to maintaining your dog’s health and training? *

Yes

No