NAME:
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OCCUPATION:
*
ADDRESS:
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CITY:
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STATE: *
AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY -Terr.- AS FM GU MI PR VI
ZIP: *
PHONE: *
E-MAIL ADDRESS: *
PLEASE DESCRIBE YOUR LIVING SITUATION (OWN/RENT, SINGLE FAMILY HOME, TOWNHOUSE, APARTMENT): *
PLEASE DESCRIBE YOUR TYPE OF YARD (SIZE, FENCING TYPE AND HEIGHT (WOOD, CHAINLINK): *
PLEASE LIST ALL MEMBERS (HUMAN) OF THE HOUSEHOLD: *
PLEASE LIST ALL PETS LIVING THE HOUSEHOLD OR PET PREVIOUSLY LIVING IN THE HOUSEHOLD.
KIND
(EX. CAT, DOG, BIRD):
*
BREED: *
SEX: *
AGE: *
SPAY/NEUTERED:
*
REASON FOR NO LONG OWNING:
*
KIND
(EX. CAT, DOG, BIRD):
BREED:
SEX:
AGE:
SPAY/NEUTERED:
REASON FOR NO LONG OWNING:
HAVE YOU EVER SURRENDERED AN ANIMAL TO A SHELTER, GIVEN AN ANIMAL AWAY OR SOLD AN ANIMAL?
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IF SO PLEASE DESCRIBE THE CIRCUMSTANCES:
ARE YOU WILLING TO COMPLETE AT MINIMUM PUPPY KINDERGARTEN AND BASIC OBEDIENCE?
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HOW MANY HOURS WILL THE PUPPY SPEND ALONE EVERYDAY?
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WILL THE PUPPY SPEND MOST OF ITS TIME?
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ARE YOU INTERESTED IN A:
MALE
FEMALE
UNDECIDED
WHAT KIND OF TEMPERAMENT ARE YOU LOOKING FOR:
*
WHAT ARE YOUR GOALS WITH THE PUPPY (CHECK ALL THAT APPLY):
FAMILY PET
CONFORMATION DOG SHOWS
BREEDING
GENERAL PROTECTION OF THE FAMILY
SPORT OF PERSONAL PROTECTION
OBEDIENCE
RALLY
AGILITY
SCHUTZHUND
WEIGHT PULLING
TRACKING
PLEASE LIST TWO REFERENCES (OBEDIENCE TRAINER, OTHER BREEDERS, OR OTHER PERSON WHO CAN VERIFY THE SUITABILITY OF YOUR HOME) AND YOUR VET INFORMATION:
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ARE YOU WILLING TO RETURN THE DOG/PUPPY TO THE BREEDER, IF YOU CAN NO LONGER KEEP IT?
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PLEASE GIVE ANY OTHER INFORMATION THAT YOU FEEL IS IMPORTANT:
*
* Required Create Email Forms
