Your full Name *
email address *
Date *
Your age *
Your occupation *
Spouse's name
Names and ages of children: *
Other occupants of home *
Home address *
City *
State *
ZIP *
Home phone (no spaces please) *
Mobile phone (no spaces please)
Does anyone in your household have allergies? *
If yes, describe:
Type of dwelling? *
Do you personally rent or own? *
Months or years at this location?
If renting, do you have landlords permission to have a dog? *
Size or weight limitation? *
Landlord name and phone? *
Type of fencing *
Highest and lowest point of fencing *
Are there gates *
Type of locks *
If no locks, would you be willing to install them prior to placement? *
Do you have a swimming pool *
If yes, is the pool surrounded by a fence with gate? *
Who has access to your yard?
I have recently inspected my fences and they are all in good condition: *
The fence is intact on all sides and is at least 6 feet from the ground in all areas *
Do you have a pet now? *
How many *
How long have you owned this (es) pets ? *
List type of pets, (if dog list breed), ages and sexes.
If you have children, please describe their previous experience with dogs. *
How many dogs live at, or are present at your residence and what is the breed of any such dog? *
Do any of your animals have any physical issues? *
Do any of your animals have behavioral issues? *
Do your animals get along with (other) dogs? *
Have you ever had multiple dogs in your home? *
How did you feed more than one dog? *
Did you have toys and bones around? *
Are your pets spayed / neutered *
Have any of your previous pets had litters ?
Have you ever surrender an animal to a shelter or rescue group ? *
Is there anyone home during the day ? *
Who
About how many hours will the dog be left alone ? *
Where will the dog stay when left home alone? *
When will the dog be inside ? *
Outside
Where will the dog sleep at night?
If inside, where exactly?
If you have additional comments on where the dog will sleep, please specify.
What rooms are off limits for the dog ? *
What outside areas are available to the dog ? *
if other, please specify.
Do you have a doggie door
Your preferred level of exercise with the dog. *
How would you socialize the dog? *
Who will groom and feed the dog *
Would the dog wear a collar *
How would you rate your level of dog owning experience? *
If other, please explain
How would you discipline the dog if he or she misbehaves? *
What, if any, behavioral issues have you dealt with in the past? *
Have you ever had any of your dogs get into a serious fight? *
If yes, please explain:
You normally walk the dog on a leash or off leash? *
If the dog escaped from your home, what steps would you take to find him or her? *
Are you willing to live with hair on the furniture, stains on your rugs, and an animal that might be destructive at times?
Please let us know appromiately how many weeks you are available? *
I understand that a home visit is required. *
Any additional comments? *
