Email Address:
Your full name (and spouse):
Your phone number with area code?:
Street address (no PO boxes):
City, State and Zip code:
How many children do you have and their 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?:
Which specific dog are you interested in?:
Do you live in a house or apartment? Do you have a completely fenced and secure yard? (NOT electric or invisible) (describe)
Where will the dog be kept during the day? Night?
Do you prefer a male or female and why?:
How did you hear about our rescue?:
Would you consider an animal that required temporary special medical care or feeding?:
Name, address, phone & fax# of current or past veterinarian:
Are you able to make the required minimum adoption donation of $300 for purebred Bouviers, mixes or wannabees, to our rescue before or at the time of adoption?:
We will not put any of our rescues on an air plane. Are you willing to drive to where the dog is currently being fostered to meet the dog that you are interested in?: