First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone*

Work Phone
x

Cell Phone*

Alt Email

Please list the dog(s) of interest:*

How long have you been at your current address?*

Do you rent or own your home?*

Landlords name and phone number (if renting):

How many adults are in the home?*

How many children are in the home?*

Does anyone have allergies to dogs? If unknown, what will you plan to do with the dog is you find out after obtaining the dog?*

What kind of fence if any do you have? How tall is it?*

What will you feed him/her?*

How much do you anticipate the cost of the dog yearly?*

How many hours a day will you spend with your dog?*

Under what circumstances would you give up your dog?*

Do you understand you cannot give the dog away without K9 Up Project Free's approval?*

Do you agree to return the dog if you cannot care for him/her?*

List previous and current pets (if applicable):*

Where are they? (if applicable):

Are they current on vaccinations? (if applicable):

Veterinarians name and address (if applicable):

Will the dog be inside or outside most of the time?*

How did you hear about us?*

Please list two contact references:*