*Dog's Name:

Dog's Description (breed, color, size, age):

Remarks:

Applicant's Personal Information

*Last Name:     *First Name:

Name of Spouse/Other Adult Living in Home:

*Address:

*City:    *State:    *Zip:

*Home Phone: Work Phone: E-mail Address:

Ages of all other family members living in the home:

Typically, how many hours are you away from home per day, working, etc.?

Do you     own     rent your house     rent an apartment?

Applicant's Home Environment Information

Do you presently have a dog   or   have you owned a dog before?

Are there cats in your home?: No     Yes     How many?

Are all of your pets spayed/neutered?: Yes     No     If not, why?

Who is your veterinarian?

Do you have a fenced-in yard?

If not, will this dog be:

    leash-walked     tied on a sliding run     secured in an outdoor kennel     trained to stay in the yard

Applicant's Dog Training Techniques

Have you ever used a crate to train a dog?

Would you be willing to purchase and use a crate if it was recommended by BARKS?

Would you seek professional training for this dog if circumstances warranted it?

Please use the space below for anything you'd like to add:

*Applicant's initials:     *Date: