Full Name: E-Mail Address: Address Home Phone Cell or Work Phone Age Occupation Employer Would you consider a dog that is NOT housebroken? Are you prepared for the work and time
required to housetrain a dog? How would you do it? Are you applying for a particular dog? Which one? Would you consider a dog over the age
of 8? Do you prefer male or female? Would you consider the
opposite sex? What weight dog do you prefer? Would you consider one between 19-25 pounds? Would you consider a dog that may have
special needs (more mature, blind, deaf, ongoing medical treatment, allergies, three legs, etc.) Number and Ages of children in home: Number of dogs in home and their breed/gender/ages/neutered
status Number of cats in home and their breed/gender/ages/neutered
status Other animals/Type/Ages Times/Hours Adult home on Weekdays Times/Hours Adult home on Weekends Where will the dog stay during the day? Where will the dog stay at night? Where will the dog stay when you travel? How do you feel about using a crate for
your dog? What are your expectations and concerns
about getting a rescued dog? Briefly explain why you believe you would
provide a great home for a rescued dog. What do you think are the cons or negatives
of a Bichon? Is this your first dog? If not, how long
ago/ Breeds/ What happened to the dog(s)/ Vet name, phone number Have you ever had to euthanize a pet?
If so, please explain. Is your home a house/condo/apt? Own or
lease? How long? Can you get owner/management documentation allowing
dog? Is your neighborhood urban or rural? Fenced yard? If so, how high? Pool? Fenced in? Cover? If you move, what will you do with the
dog? If you can no longer care for the dog,
who will take over? What is your time frame for obtaining a dog? Estimate your monthly grooming expenses. Estimate your annual veterinary espenses. What types of items do you expect to purchase
for your dog? Are you prepared to make a donation for a Rescue that
will generally range from $100 to $300? Please list other members of your household
(names, ages, occupations) Current Veterinarian: name, address,
telephone I hereby authorize any veterinarian named above to
release any information and records concerning my care of animals to whoever may present this application and I do hereby
agree to hold harmless and indemnify said veterinarian for providing such information. Signature: Date submitted
