*Name
*Street Address
*City
*State
*Zip Code
*Email
*Telephone
Alternate Phone
Please list below the number of children in your home and their ages:
If any family members have allergies, please indicate type and severity.
*Gender preferred Male Female Gender does not matter.
*Color preferred
*Size preferred Miniature (20-30 lbs) Medium (30-40 lbs) Standard (over 40 lbs)
*Where will the puppy be kept during the night?
*Where will the puppy be kept during the day?
*Will there be someone available to feed and exercise the puppy during the day? Yes No
*How many hours on average will the puppy be left alone?
*How many hours a day will the puppy be kept outside?
*How will your puppy be confined when outside?
*Does your home have stairs? Yes No
*What kind of floor surfaces will the dog be on in the house?
*Have you ever owned a dog before? Yes No
*Have you ever house-trained a dog before? Yes No
*What do you expect the activity level of this breed to be? Below average Moderate High Very high
Please list below any other animals in your home and their ages:
*Will you be attending any training classes? Yes No Undecided
How long did your last pet live? What were the circumstances of its death?
*Have you ever returned a pet to the breeder? If so, what were the circumstances?
*Have you ever given a pet away? If so, what were the circumstances?
*Have you ever taken a pet to a pound or shelter? If so, what were the circumstances?
Is there anything else you would like for me to know about your family or circumstances?
*Required
