BREEDING DOG HOME APPLICATION

Name *

Age (If Minor)

Address *

Address

City

State/Province

Zip/Postal

Home Phone *

Cell Phone

Work Phone

Email *

Place of Employment/Occupation

Household Members

Name

Age (If Minor)

Relationship

Place of Employment/Occupation

Add Remove

Pet Background

Have you ever owned a dog? *

Yes

No

Have you owned any other animals? *

Yes

No

Are there currently any other dogs residing in the home? *

Yes

No

Are there any animals housed outdoors? *

Yes

No

If yes, list here: *

Have you ever trained a puppy or a dog? *

Yes

No

Have you ever whelped puppies? *

Yes

No

Have you ever housed an intact dog in the past? *

Yes

No

Responsibilities

Will the dog be left home alone during the daytime? *

Yes

No

If yes, how many hours? *

Is your yard completely fenced in? *

Yes

No

If not, do you agree to provide a kennel run or a trolley style tie out for the dog? *

Yes

No

Do you agree to keep the puppy on a leash at all times unless it is a completely fenced in area? *

Yes

No

Do you agree to exercise the puppy daily? *

Yes

No

If housing an intact female, do you have ample room for whelping and care of the puppies once born? *

Yes

No

Do you have support of all family members in the home? *

Yes

No

In the event of family illness, emergency, or vacation time what provisions will be made for the care of the dog? *

Do you feel comfortable with your knowledge of basic dog care and first aid for dogs? *

Yes

No

If not, are you willing to learn? *

Yes

No

Do you have a Veterinarian you are currently using? *

Yes

No

May we contact your veterinarian for a reference? *

Yes

No

Name of Veterinarian: *

Phone *

Address

Street 1

Street 2

City

State/Province

Zip/Postal

How much time are you able to commit for the daily care and training of a dog? *

When would you be available to take a dog? *

Do you have a preference for a specific breed of dog? *

Do you have a preference for a male or female dog? *

Male

Female

First Available

If you do not own your home or live in an apartment, do you have permission from the landlord to have a dog? *

Yes

No

Are you aware of the financial commitment (vaccinations, food, obedience classes, monthly heartworm, cleaning/whelping supplies medication) that occurs when housing a breeding stock dog? *

Yes

No

Are you aware of the time constraints in housing a breeding stock animal? *

Yes

No

Personal Reference #1

Name *

Phone *

Address

Street 1

Street 2

City

State/Province

Zip/Postal

Relationship *

Personal Reference #2

Name

Phone

Address

City

State/Province

Zip/Postal

Relationship

Personal Reference #3

Name *

Phone *

Address

City

State/Province

Zip/Postal

Relationship *

Breeding Host Classes

Do you agree to attend monthly obedience classes with the breeding stock dog? *

Yes

No

Where will you attend obedience classes? *

How did you hear about the Paws With A Cause Breeding Host Program? *

Household Members

Pet Background

Responsibilities

Personal Reference #1

Personal Reference #2

Personal Reference #3

Breeding Host Classes