How did you hear about us? Describe your perfect puppy (personality, color, size) Names and ages of all household family members Does everyone in your household approve of getting a dog?  Yes  No Family interests and hobbies

Describe your home environment

Do you own or rent?  Own  Rent If you rent do you have your landlord's permission to have a puppy?  Yes  No Do you have a fenced yard?  Yes  No Are you able to take your dog on daily walks?  Yes  No Percent of the time the dog be alone: Reasons you want a dog Additional information you would like to share