Adoption Application

1. Please provide the following information:
   (all questions must be answered for your application to be submitted)

   First Name
   Last Name
   Street Address
   City
   State	Select State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY
   Zip Code
   Primary Phone	-  Home Phone Cell Phone Work Phone
   Secondary Phone	-  Home Phone Cell Phone Work Phone
   E-mail
   Preferred Method of Contact	Home Phone Cell Phone Work Phone Email

2. Would you like a male or female puppy?

   Male Female Either
   

3. What color of puppy do you desire?

   Chocolate Black White Cream Red Does Not Matter

4. What type of coat do you prefer?

   Curly Fleece Wavey No Preference

    

5. Does anyone in your family have allergies?

   Yes                No
   

6. Are there children in your family? If yes, please give their ages.

   
   

7. Are there other pets in your family? If so, please list type of animal(s) that will be living in the household with the puppy.

    

8. Do you live in a.... House Apartment Mobile Home Condo

9. How do you plan to provide exercise for your dog?

10. Do you have a fenced in yard? If not, how do you plan to provide confinement and protection for your dog?

11. Where will you keep the puppy during the day?

12. Who will care for your puppy while you are at work or gone for extended periods of time?

13. Should you find yourself unable to care for your puppy we request that you notify us so we may assist in finding a new home for your dog. 

        Do you agree to this?
        Yes No

        If not, please explain why.

14. How did you learn about us?

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