Please enable JavaScript in your browser to complete this form.Which puppy are you interested in adopting? *BaxterBosleyPersonal DetailsAdopter's Name *FirstLastPhone *Email *Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeDo you currently have any dogs? *YesNoHow many?Is your property fenced? *YesNoPartiallyWill your dog live inside or outside? *Please list any other animals that will share the property with your dog *Do you rent or own? *HomeownerRenterDo you have children in the home? *YesNoHow many hours a day are you home? *1-45-910-1920-24Additional InformationWho will care for your dog when you travel. *What activities do you plan to do with your dog? *Are you willing to have an in home inspection done? *YesNoAre you willing to sign an intent to spay/neuter agreement? *YesNoContactsVeterinarian's Name *FirstLastVeterinarian's Phone NumberReferencesName *FirstLastEmail *PhoneName *FirstLastEmail *PhoneName *FirstLastEmail *PhoneHave you ever been issued a warning/citation for Humane Violations against animals *YesNoHave you ever surrendered, re-homed, or euthanized a dog for any non-health related reasons: *YesNoWill the dog be tethered in your yard? *YesNoWill you be providing your dog with annual heartworm prevention medication: *YesNoAre all your dogs and cats spayed or neutered? *YesNoAre all your dogs and cats up to date on vaccinations? *YesNoDo you certify that the information provided in this form is true and accurate? *YesNoAre you over 18? *YesNoSubmit
