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Family Information
Applicant’s Name: Address: City,
State, Zip: Home Phone: Other Phone: Email Address:
Breed of puppy wanted: Male,
Female or either: Color of puppy wanted:
What expectations/qualities are you looking for in your pup? Will
this pup be for companion, family pet, performance (show/agility/etc.), breeding, therapy, service, etc?
How many people
live in hour household? Ages of children: Who will be the primary caretaker of the puppy? How many hours each day
will your puppy be alone on his/her own? What other pets do you currently have? Have
you ever owned/or had contact with a dog that developed parvo? If yes, how long ago?
Do you rent/own? Have you cleared
this with your landlord/manger and other members of your household? What type of set up will you provide for your pup/dog?
Have you selected a Veterinarian yet? Will you neuter/spay? Do you plan to
breed? Any other comments you would like to share:
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