YOUR-NAME

    YOUR-ADDRESS

    CITY,STATE,ZIP

    YOUR-EMAIL

    YOUR-PHONE

    YOUR-GENDER

    PARENT/GUARDIAN NAME IF UNDER 18

    HAVE YOU OWNED A DOG BEFORE

    WHAT TYPE OF HOME DO YOU LIVE IN: APT. SINGLE STORY,TWO STORY, HIGH RISE, OTHER

    PLEASE LIST THE PEOPLE LIVING IN YOUR HOME. NAME, AGE AND RELATIONSHIP

    PLEASE LIST ALL THE ANIMALS THAT LIVE WITH YOU NOW OR VISIT YOUR HOME OFTEN(INCLUDE AGE AND BREED)

    ARE YOU A STUDENT?

    IF YES, PLEASE PROVIDE THE SCHOOL NAME AND YOUR GRADE LEVEL

    PLEASE LIST YOUR ACTIVITIES, SPORTS AND HOBBIES

    PLEASE DESCRIBE YOUR TYPICAL DAY

    HOW WOULD YOU DESCRIBE YOUR SELF? HIGH ENERGY, MODERATE TO ACTIVE, LOW KEY, OTHER

    DO YOU TRAVEL?

    DOES ANYONE IN YOUR HOME SMOKE TOBACCO PRODUCTS?

    WHAT TYPE OF SERVICE DOG ARE YOU INTERESTED IN?

    PLEASE SHARE ANY OTHER PERTINENT INFO

    WHAT IS THE BEST TIME TO REACH YOU? ANY, EARLY MORNING, MIDDAY, LATE AFTERNOON OR EVENINGS