Full Name*

Email*

Physical Address*

Mailing Address *if different

Phone*

Drivers License Number*

What type of dwelling do you live in?*

Do you have a fenced yard?*

Who is your current Veterinarian?*

What is your occupation, and how long are you typically gone during the day?*

Where do you plan to keep your new dog when you are not home?*

Where do you plan to keep your new dog at night? Inside/outside?*

How would you describe the level of activity of your household? *

Who will ultimately be responsible for feeding, socializing and training your new dog? *

What pet behavior problems have you experienced in the past, and how would you resolve them? *

Do you plan to move or go on an extended vacation in the next 6 months? *

If you have to move, what do you plan to do with your new dog?

On average, it may take your new dog one month or longer to adjust to its new home and routine, especially if you have other pets. Are you willing to allow for this adjustment period?*

Under what circumstances will you absolutely not keep this dog? *

Why are you interested in adopting this particular dog? *please list dog name*