Name *

First Name

Last Name

Phone

(###)

###

####

Have you ever owned a dog before? *

Yes

No

Do you have a fully fenced yard? *

Yes

No

Has everyone in your household agreed to get a puppy? *

Yes

No

During the first 3 months that you have your puppy, how much will your puppy be left home alone? *

Never.

Occasionally, for 1 hour or less per day.

Occasionally, for 2-4 hours per day.

Regularly, for 2-4 hours per day.

Regularly, for 4+ hours per day.

Please check the box that best applies: *

I own my own home/condo and dogs are permitted on my property.

I rent my home and I have obtained permission from my landlord to have a dog.

Neither of the above apply to me.