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Your information:
First Name
*
Last Name
*
Email Address
*
Street Address
*
Apartment, suite, etc
City
State/Province
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Australia
Aruba
Austria
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Benin
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Bhutan
Bolivia
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Bouvet Island
Brazil
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Brunei
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Burkina Faso
Burundi
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Cameroon
Canada
Cabo Verde
Cayman Islands
Central African Republic
Chad
Chile
China, People's Republic of
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
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Ethiopia
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Finland
France
France, Metropolitan
French Guiana
French Polynesia
French South Territories
Gabon
Gambia
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Germany
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Ghana
Gibraltar
Greece
Greenland
Grenada
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Guam
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Guinea-Bissau
Guyana
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Heard Island And Mcdonald Island
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Hong Kong
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Indonesia
Iran
Iraq
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Jordan
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Korea, Republic of
Kosovo
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Morocco
Mozambique
Myanmar
Namibia
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New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
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Northern Mariana Islands
Norway
Oman
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Palestine, State of
Panama
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Suriname
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Tajikistan
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Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis And Futuna Islands
Western Sahara
Yemen Arab Rep.
Yemen Democratic
Zambia
Zimbabwe
Do you own or rent?
*
Own
Rent
Phone Number
*
About your household:
Have you owned a dog before?
*
Yes, but not currently
Yes, I currently have a dog
No
What kind of dog do you currently have?
*
Dog's Weight in Pounds:
*
Dog's Age
*
Do you have children or elderly people in the household?
*
No
Children under 8yrs
Children 8yrs and older
Elderly
Do you have cats or other animals in the household?
*
No
Cats
Other
What other animals are in the house?
*
My dog will primarily be:
*
An indoor dog
An outdoor dog
How many hours a day will your dog spend outside?
*
How many hours will your dog spend alone each day?
*
When I'm gone my dog will be:
*
In a crate in the house
Loose in the house
In the yard
When I am home I want my dog to be by my side:
*
The majority of the time
Some of the time
I don't want my dog by my side
What kind of collar/harness will your dog use?
*
Harness
Simple leash and collar
Pinch collar
Please let us know the kind of dog you are looking for:
I want a guard dog:
*
Yes
No
I want my dog to hunt or heard with me:
*
Yes
No
I want my dog to be enthusiastic in the way it loves people:
*
Very
Somewhat
Not at all
I want my dog to be playful:
*
Very
Somewhat
Not at all
I want my dog to be laid back:
*
Very
Somewhat
Not at all
I am comfortable doing manner correction training:
*
Very
Somewhat
Not at all
I want to participate in Agility, Flyball, or Obedience classes with my dog:
*
Yes
No
I'm interested in a dog with special needs (medical or behavioral):
*
Yes
No
Possibly
It is most important to me that my dog:
*
Please prodide us with current or former veterinary clinic information:
Veterinarian's First Name
Veterinarian's Last Name
Clinic Name
Clinic Phone
Please provide two personal references:
First Name
*
Last Name
*
Phone
*
Relationshp
*
First Name
*
Last Name
*
Phone
*
Relationshp
*
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