Application For Puppy or Older Adult

Information submitted will be kept strictly confidential and will not be shared with any other organizations for any purposes. It will only be used for the purposes of determining eligibility for adopting one of our puppies/dogs, and for assisting in determining a compatible puppy/dog for your family. 

A $100 non-refundable fee will be required to hold a puppy for you. Once pups are born an additional down payment will be required.

Please note: WE WILL NOT SELL OUR DOGS AS GIFTS.

Current Rates for our dogs are available by contacting us.

We will contact you once we review your application. If you have trouble with the application please contact thru the feedback form or give us a call. Thank you.

please visit out facebook page at https://www.facebook.com/2019mydream/

Title:	Mr. Mrs. Ms. Miss Dr.
Name:
Email Address:
Home Address:
Province/State:
Country:
Postal Code:
Phone Number:	( )- -
# Adults In Your Home:
# Children In Your Home:
Ages Of The Children:
Have You Owned A Dog Before?	No Yes
If Yes:	# Dogs Currently In Your Home: Please List Breed/Age/Sex Of Dogs You Have Owned In The Past That Are No Longer Living With You, Their Approximate Dates Of Ownership, And Why The Dog(s) Are No Longer Living With You: Please List Age/Breed/Sex Of Dogs Currently Residing In Your Home (In Respective Order Of Age, If Neutered Or Spayed, Please Indicate), As Well As Their Approximate Dates Of Ownership:
Other Pets Currently Living In Your Home: (Please List Quantity And Type):
Residence:(Please Select All That Apply):	Own Home Renting Single Family Home Condo (apartment style) Condo (row housing) Apartment Row House Duplex Acreage
Yard Type:	Fenced Unfenced
Are You Planning To Move In The Next 3 Years?	Yes No
The Longest Time Your Puppy / Dog Would Be Left Home Alone:
Preferred Age Of Dog:	Puppy Retired Young Adult Either
Preferred Sex of Dog:	Male Female Either
Do You Intend To Show Your Puppy?	Yes No
Do You Plan To Put Your Puppy In Obedience Training?	Yes No
Do You Intend For Your Puppy To Participate In Agility Classes/Competitions?	Yes No
Please Tell Us What Types Of Things You'll Be Doing With Your Puppy/Dog (example: Companion, Jogging, Agility, etc.):
Do You Have A Veterinarian Selected Already?	Yes No Need A Referral
If Yes:	Veterinarian's Name:
	Veterinarian's Address:
	Veterinarian's Phone Number: ( )- -
Do You Have A Groomer Selected Already?	Yes No I Will Groom It Need A Referral
If Yes:	Groomer's Name:
	Groomer's Address:
	Groomer's Phone Number: ( )- -
Please Provide Three References:	Name:
	Phone Number: ( )- -
	Name:
	Phone Number: ( )- -
	Name:
	Phone Number: ( )- -

Image Verification Please enter the text from the image   [ Refresh Image ] [ What's This? ]

Form by thesitewizard.com