Name of Applicant
Email Address
Work #:
Home #:
Cell #:
Street Address
City
State
Have you owned a Bouvier before? Please Describe.
If yes, where/from who did you get your Bouvier
Are you interested in a puppy
Yes No
Cropped Ears
Yes No
What timeframe?
Immediately Within 3-6 Months Just Searching
Are you interested in (check all that apply):
Pet Show Agility Obedience Herding Service Therapy Work Protection
Number of People in Household
Number of Children
Age of Children (check all that apply):
Infant Under 5 years old 6-10 years old 11-15 years old
Will the Bouvier be kept inside?
Yes No
Are there other dogs in the home?
Yes No
# of Dogs
Male/Female?
Age(s)
Breed(s)
Neutered
Yes No
Spayed
Yes No
# of Cats
Ages of Cats
Horses?
Yes No
Livestock?
Yes No
How large is your yard? (Check all that apply):
Typical Suburban Yard Acreage Apartment
Is your yard securely fenced?
Yes No Does Not Apply
Is there a swimming pool?
Yes No
Do pets have access to it?
Yes No Does Not Apply
How many days a week do you work?
How many hours per day are you gone from the house?
How often do you travel?
Rarely Once a Month Weekly
When you are gone from the house, where will you keep your dog?
How will you exercise the dog?
Do you understand the importance of socializing your dog? Please explain.
Will you attend obedience classes with your dog?
Yes No
In addition to the purchase price of the dog, are you willing to invest an additional $300-$500 for a crate, leash, collar, spay/neuter, microchip?
Yes No
Name, address and telephone number of your vet?
Name, address and telephone number of your groomer?
Have you ever had to return a dog to a breeder, give a dog away or euthanize a young dog? Please explain.
Who or what brought you to War Bouviers? .
Past Client
Referral
Dog Show
Internet
Other
