(Page 1 of 4)

Name
DL Number
Addresss
PO Box
City/State
Zip
Phone	(Home)  (Work)
May we call you about our dogs?	Yes No
Names of others in household (Include ages for children)
Length of time at this address	Own Rent Live with Parents Military
Housing Type	House Condo Apartment Mobile Home
Landlord Name
Landlord Phone
How did you hear about our  Olde English Bulldogges?
Does everyone in your household  agree to make a commitment to the  responsibilities of owning a dog?	Yes No
Do you agree to pay a  home placement fee?	Yes No
Do you agree to pay for transport  of the dog to your home?	Yes No
Please list your current veterinarian
City	Phone

 

 

Current Pets (Page 2 of 4)

 

Type
Name
Age	Sex  Male Female
Spayed/Neutered	Yes No
Kept	Indoors Outdoors Both
How long have you owned this pet?
Type
Name
Age	Sex  Male Female
Spayed/Neutered	Yes No
Kept	Indoors Outdoors Both
How long have you owned this pet?
Type
Name
Age	Sex  Male Female
Spayed/Neutered	Yes No
Kept	Indoors Outdoors Both
How long have you owned this pet?
Type
Name
Age	Sex  Male Female
Spayed/Neutered	Yes No
Kept	Indoors Outdoors Both
How long have you owned this pet?

 

 

  

You & Your Household (Page 3 of 4)

 

Dog Ownership Experience	First-Time Owner Have Owned One or Two Knowledgeable & Experienced
Time Away from Home	Home All Day Out Part-Time Away 7-10 Hours Daily
Our Dog Will Live	Indoors Outdoors Both
Home Atmosphere	Grand Central Station Some Activity Zen Garden Serene

 

Your Ideal Dog

 

Describe the Attributes of  Your Ideal Dog
Temperament
Adult Size
Appearance
Age	8-16 Weeks 4-12 Months 1-3 Years Older No Preference
Training	Housebroken Some Obedience Training Fully Trained
Activity Level	Low Medium High
Sex	Male Female No Preference

 

 

  

 

Complete & Sign Document (Page 4 of 4)

 

Please include any additional  information you would like to share

 

 

Please Read and Certify the Following

I certify that all information in this application is true, and I understand that false information may void this application. I agree that upon adopting a dog from Insightout Kennel, I will abide by their Home Placement Agreement.

Yes I certify that this is true

(Your Typed Name Will Serve as Your Signature)