EmailMe Form - Few Steps From Home Dog Application

First , Last

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email

Phone

### - ### - ####

Date Time

MM / DD / YYYY

Name of Animal you are applying for

name of animal you are applying for

Have you ever owned this breed before?

have you owned this type of breed before?

How many pets do you currently own?

Please list breeds of dogs you currently have. please list other types of animals you have and ages of all animals.

Please list the dogs you have owned as an adult and how each one has passed away and ages of the dog

Please list personal reference that is not a family member.

Phone number

Please list personal reference that is not a family member.

Phone number

Please list personal reference that is not a family member.

Phone number

Veterinarian your pets records have/or have been at, as well as phone number, address

Can you afford regular vet care?

yes

no

I don't know

Can you afford regular vet care?

Do you agree to regular vet check ups and annual vaccinations as needed?

yes

no

maybe

Do you agree to regular vet check ups and annual vaccinations as needed?

How many children are in your home and what are their ages? Have they been around dogs before?

If you have children at a later date would this make you want to give up on your dog?

how many adults are in your household?

1

2

3 or more

how many adults are in your household?

who will be looking after the new dog?

Is everyone in agreement in the home with the new dog?

yes

no

have not discussed it

Is everyone in agreement in the home with the new dog?

How do you feel about crating a dog? Would you be willing to if needed?

How many hours will the dog be left alone a day?

Will you take the dog to training classes if needed?

Do you have a Fence? if so, what kind? how high is it?

If you do not have a fence how will you be taking the dog outside to go to the bathroom and to get exercise?

What form of discipline will you use for your new dog? what have you used in the past?

do you currently, or have you ever bred animals in the past?

How long will you give your dog to adjust to it's new surroundings?

What will you do if your dog shows destructive behavior?

If your dog ran away what would you do? have any of your dogs accidently been loose before? if so how?

Do you rent or own your home? (if you rent please complete the below section on the landlord)

landlords Name

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone

### - ### - ####