Owner's Name *

First Name

Last Name

Co-Owner's Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Owner's Phone *

(###)

###

####

Co-owner's Phone

(###)

###

####

Dog's Sex *

Male

Female

Is this dog spayed/neutered? *

Yes

No

Is your dog microchipped? *

Yes

No

Unknown

Is there a clause in your adoption contract that requires you to return the dog to the breeder or rescue, if you can no longer care for the dog? *

Yes

No

N/A

Have you contacted the breeder or other rescue? *

Yes

No

N/A

Has your dog been used for breeding? *

Yes

No

Has your dog ever bitten anyone? *

Not puppy playful nipping.

Yes

No

Does your dog have any bad habits? *

Please check all that apply

Barking

Chewing

Digging

Fence Climbing

Jumping on People

Counter Surfing

Resource Guarding

None of these

Is your dog reliably housebroken? *

Yes

No

Has your dog been crate trained? *

Yes

No

Does your dog like other dogs? *

Yes

No

Unknown

Does your dog like cats? *

Yes

No

Unknown

Does your dog like children? *

Yes

No

Unknown

Does your dog prefer men or women? *

Men

Women

No Preference