Name*

Address*

Email*

Phone number*

Puppy name*

Puppy age (incude date of birth if known)*

Puppy breed, if known. If not known or unsure, please tell us your best guess. If DNA testing was used, please let us know.*

Where did you obtain your puppy (breeder, shelter, rescue, stray, etc.)? Include name of breeder or organization if applicable.*

Date puppy arrived in your home*

Which Proton Puppy package are you requesting?*

What are your goals regarding puppy training and socialization?

I acknowledge that veterinary records, including proof of vaccination and fecal testing, may be required if I elect to attend an in-person field trip.*