Your phone number (with country, city, area codes):
How many Children do you have and what are the ages? Who wants a dog and why?Breed, sex & age of dogs currently owned: Are they spayed or neutered? Do you own other animals? how many and what kind? Would you be interested in a bouv-mix? Do you live in a house or an apartment? Fenced yard? Where will the Bouvier be kept during the day? night? Do you prefer a male or female? why? How did you hear about the rescue? Would you consider an animal that required temporary special medical care or feeding? Current/Past Veterinarian, address, phone# and fax#Are you able to make the suggested donation ($200) to our rescue before or at the time of adoption?Are you willing to drive or pay transporting?