|
Name
|
|
|
Street Address
|
|
|
City, State and Zip Code
|
|
|
Home Phone
|
|
|
E-mail Address
|
|
|
Date of Birth
|
|
|
Do you live with
|
|
|
How many adults (21 and over) are in your household?
|
|
|
What are the ages of the individuals under 21 in your household?
|
|
|
Dog's Living Situation
|
|
|
How many hours a day will the dog be left alone?
|
|
|
When home alone, the dog will be:
|
|
|
How will you exercise the dog?
|
|
|
Do you live in a house or apartment?
|
|
|
Do you own the property?
|
|
|
If you are renting, please provide landlord's name and telephone number for verification
|
|
|
Do you have other dogs? (Check all that apply)
|
|
|
Please specify breeds and ages of other dogs
|
|
|
If you had other dogs in the past, please advise of their current disposition:
|
|
|
Please specify what happened
|
|
|
What other kinds of animals do you own?
|
|
|
Do you have any experience with the breed? If so, please describe:
|
|
|
Does everyone in your household want this dog?
|
|
|
Who will be the primary caretaker of the dog?
|
|
|
Does anyone in your household have allergies? If so, please specify.
|
|
|
Are you willing to work with this dog on any issues he/she may have?
|
|
|
REFERENCES: Please provide: (1) Name (2) Telephone Number (3) E-mail Address (4) Relationship and (5) length of time known for 3 individuals who can verify your ability to care for this animal.
|
|
|
Additional information you would like to provide about yourself.
|
|
|
* By checking YES you agree to absolve PIT MOUNTAIN and all of its representatives from any liability in reference to a dog featured in this web site
|
|