Your Name:

Address:

E-mail:

Phone:

Home:

Own Rent

Significant Other:

Children in home/Ages:

Goals for your dog:

Yard fenced or willing to fence?

Yes No

Where will puppy live?

Caregiver for puppy during daytime:

Are you willing to crate train?

Yes No

Will you do obedience training?

Yes No

Have you ever owned a dog before?

Yes No

If yes, what happened to it?

Have you ever brought a dog to a shelter or pound?

Yes No

If yes, what were the circumstances?

Are you willing to make a 10-16 year commitment to this dog?

Yes No

Are you able and willing to cover health care costs exceeding $?1000.00?

Yes No

Are you willing to follow advice regarding your puppy's care?

Yes No

Color Preference:

Chocolate Black No Preference

Male/Female Preference:

Male Female No Preference