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