Name of Dog You Are Interested in:

Today's Date

Name

Date of Birth

Address

City

State

Zip

Email Address

Home Phone

Cell Phone

Work Phone

Number of adults in the home (besides you).

Number of children in the home.

Age of Children

Number of cats in the home.

Number of dogs in the home.

Size or Breed of Dog(s)

What is the activity level of your dog(s)?

Are all pets in your household spayed/neutered? Are all pets in your household spayed/neutered? Yes No

Are all pets in your household current on their immunizations? Are all pets in your household current on their immunizations? Yes No

Does anyone in your house have any known allergies to dogs? Does anyone in your house have any known allergies to dogs? Yes No

Do you own or rent your residence? Do you own or rent your residence? Own Rent

Landlord Name

Landlord Phone

Have you owned a dog (or dogs) in the past that you no longer have? Have you owned a dog (or dogs) in the past that you no longer have? Yes No

List name(s) and provide a brief history of why you no longer have the dog(s).

If any of your previous dogs are deceased, please list dog(s)' name(s), date(s) deceased and terms of death.

Do you have a fenced-in area on your property? Do you have a fenced-in area on your property? Yes No

How high is the fence? How high is the fence? 3 feet 4 feet 5 feet 6 feet or greater

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

What are the working hours of the adults in the household?

Where will the dog be kept during the day?

Where will the dog be kept when left alone?

How long will the dog be left alone during the day?

How do you plan to exercise the dog?

Where will the dog sleep at night?

Are you willing to take your dog to a trainer or obedience class? Are you willing to take your dog to a trainer or obedience class? Yes No

How would you handle adjustment/training problems such as 1) jumping on furniture, 2) jumping on people, 3) barking, 4) chewing, 5) house soiling.

Vet Name

Vet Phone

Name(s) of Current Pet(s)

Person's Name on Vet Records

Name of 1st Reference

Telephone of 1st Reference

Relationship to 1st Reference

Name of 2nd Reference

Telephone of 2nd Reference

Relationship to 2nd Reference

By entering your initials in this field, you certify that the information you have given is true, and you understand that Waldo's Muttley Crew may contact your veterinarian, personal references and landlord (if applicable) to verify the information on this form.