FULL NAME

PHONE NUMBER

STREET ADDRESS

CITY/STATE

ZIP CODE

Do you have other animals inside/outside the home?

If Yes- please list how many animals/ the sex of other animals/ and if they are friendly towards new dogs-- Enter N/A if answer is 'No'

How many hours per day will the puppy be alone? Please list below--

Do you have children present in the home?

If Yes- please list their age and how many below-- Enter N/A if answer is 'No'

Do you plan to take puppy/dog to group classes?

Do you need transport or do you plan to pick up puppy?

Do you have a fenced in yard?

Do you own your home?

Preferred Sex

Female

Male

No Preference

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