Name * First Name Last Name Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country How Did you hear about us? Puppy Preferences Gender: * Male Female Either What Color are you interested in: Are you interested in a specific breed? * What age range are you looking for: * 8wks - 6 months 6 months -12 months 12 months and older What temperament are you looking for: * Companion Therapy Service Are you applying for a specific dog? Name: Family Information Does anyone in your household have allergies or asthma? * Yes No Does anyone in your household have a disability? * Yes No Age range of adults in home: * (check all that apply) 21 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80+ Are they any children in your home? * Yes No Do you have any other pets? * Yes No Have you ever had a dog? * Yes No Explain? Housing Information Do you: * Own Rent Other Are there any restrictions or covenants pertaining to dog ownership where you live? * Yes No How will you plan on containing your dog/puppy? * Traditional Fence Invisible Fence Tie-Out Other What sort of lifestyle do you live? * Active Semi-Active Sedentary What is your profession(s)? * Puppy Information Do you plan on using a crate with your puppy? * Yes No Where will your puppy/dog be kept during the day? * Do you have a current vet? * Yes No Can we contact your vet? * Yes No Commitment Are you aware that a puppy/dog takes a lot of work and consistency? * Yes No Will the cost of caring for a new puppy fit into your budget? * Yes No How much yearly do you think a puppy/dog will cost? * Are you committed to caring for this dog for his/her lifetime? * Yes No Do you agree to provide your puppy/dog with all necessary veterinary care to maintain good health? * Yes No Do you agree to contact us if you are no longer able to care for this puppy/dog so that we can assist you in rehoming him or her? * Yes No Do you agree to never relinquish this puppy/dog to a shelter? * Yes No Do you understand that a puppy/dog is a lifetime commitment. You are committing to your dog for the length of its life, this can be up to 15 years. Are you ready for that commitment? * Yes No It is important to maintain your dog’s health and its training during that time. A healthy well-behaved dog is a happy dog. Do you commit to maintaining your dog’s health and training? * Yes No Thank you! Application