Have you ever been convicted of a felony?

    YESNO

    Interested In (dog’s name):

    Today’s Date:

    Personal Information

    First name:

    Last name:

    Birth date:

    Social Security Number:

    Drivers License Number:

    Email (required)

    Street Address 1:

    Address Line 2:

    City:

    State:

    Zip:

    Housing

    Type of housing:

    Can you provide a copy of lease (if applicable):

    YESNO

    Landlord’s name:

    Landlord’s phone number:

    Years at current address:

    If under 2 years, previous address:

    Home phone number:

    Cell phone number:

    Marital status:

    How many adults in the house:

    Name, age and relationship of other adults:

    1.

    2.

    3.

    4.

    5.

    How many children in the house:

    Age of children:

    Do you have a fenced yard or kennel run?

    YESNO

    If so describe:

    Does anyone in the home have allergies:

    YESNO

    Do all the adults in the house want a pit bull?

    YESNO

    If not, who and why:

    Are there other dogs in the house?

    YESNO

    If so please provide breed, sex, age and if they are spayed/neutered:

    Any cats in the house:

    YESNO

    How many other animals have you had in the past 5 years:

    Where are they now? Still alive, put to sleep, given away, lost, hit by a car:

    Work

    Employer address:

    Employer phone number:

    Years at employer:

    Typical hours worked:

    Care

    How will you handle exercise and potty needs:

    How many hours will the dog be left alone:

    Who will be the primary caregiver of the dog:

    Why do you want a pit bull:

    Describe your lifestyle:

    Where will the dog live primarily:

    What activities will your dog participate in:

    Will you crate your dog when needed?

    YESNO

    If no, why:

    How will you handle mischievous behavior, digging, chewing, etc:

    How will you handle any unwanted behavior:

    What would cause you to return the dog:

    Are you prepared for the personal attention this breed needs:

    YESNO

    Do you have the time and ability to train and exercise a strong, large dog

    YESNO

    Are you ready to commit the next 10-16 years to this dog:

    YESNO

    Current vet’s name:

    Current vet’s address:

    Current vet’s phone number:

    References

    Please provide 2 personal references (not relatives)

    1.

    Name:

    Address:

    Phone number:

    Relationship:

    2.

    Name:

    Address:

    Phone number:

    Relationship:

    Please provide 2 family members who will know your whereabouts for the next 5 years:

    1.

    Name:

    Address:

    Phone number:

    Relationship:

    2.

    Name:

    Address:

    Phone number:

    Relationship:

    THE INFORMATION ON THIS APPLICATION WILL BE KEPT CONFIDENTIAL.

    BY SUBMITTING THIS APPLICATION, I CERTIFY THAT ALL INFORMATION PROVIDED IS COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT YOU MAY RUN A BACKGROUND CHECK AND WILL CHECK ALL MY REFERENCES.

    AGREE and DIGITALLY SIGN.

    Partners: