Puppy Waiting List Application Form

Fields marked with * are required.

Full Name*

Telephone*

Telephone #2

E-mail Address*

Street Address*

States*

Zip Code*

# of Children in the home*

Age of youngest child

Do you have a securely fenced yard?*

Will this puppy be an indoor dog?*

Yes No

Do you / did you have any other pets? What kind, and what happened to them?*

What are your plans for this puppy? (show, breeding, companion, therapy, etc.)*

Do you plan on training him/her yourself, attending a class, or hiring a private trainer?

Do you plan on grooming yourself or hiring a professional groomer?

Does anyone in your household smoke?*

yes no yes, but only outdoors

Who will be primarily responsible for the care of this dog?*

Do you prefer a male or female puppy?

Male Female It does not matter

If you have any other information that you think that we should know, please type it here.

If you have any questions, please type them here.

WebForm Service Provided by Doteasy Web Hosting for EASTCOASTWESTIES.COM