Puppy Application

*denotes a required field

Name:* Email Address:*

Address:

City: State: Zip:

Country:

Home Phone:* Work Phone:

How did you hear about us?

Please take your time answering the following questions;
answer all the questions.
Give us as much information as possible; if you need more room,
please use the comment section and label with the correct question number.

1. In what type of housing do you reside?

2. Do you live:

3. Do you

If you rent, does your landlord permit dogs? yes no

Would you permit us to contact your landlord? yes no

Landlord's name and phone number:

4. Do you have a fenced yard? yes (in feet) no

Are you able to leash walk your dog at least 4 times daily for necessary functions? yes no

If no, why?

5. My household consists of the following number of:
Adults Children dogs cats other

My children's ages: Adult ages:

My dogs are (list age, sex and breed):

6. I have owned dogs in the past

7. My dogs were: because:

other reasons:

8. Does anyone in the household have allergies? no yes, what type?

9. Do you expect to have children? yes no

10. Do you have a person living in the household that is

11. I am interested in a pet and plan to spay/neuter: yes no

12. I am interested in showing and/or breeding: yes no

13. I am interested in training my dog in:

14. My dog will spend most of his/her time:

15. The temperament I expect from my dog, as per the following possibilities would be:

The mailman knocks at the door with a package delivery, I want my dog to:

other, please explain

16. I would like a:

17. I would like a:

18. I would like a:

19. Which family member will have the major responsibility for the dog?

20. How many hours a day would the dog be left alone? hours

21. If necessary, are you willing to crate train your Shiloh? yes no

22. Do you agree to return your Shiloh to us at Timber Lane Shilohs if you are unable to keep it? yes no

23. Are you willing to keep the dog up to date on all of its vaccines, screen for heartworm, use heartworm preventative and use flea preventative? yes no

24. Are you willing to:

25. Are you willing to have your dog seen by a vet at least once a year? yes no

26. Are you willing to license your dog, keep it properly identified and abide by your state and local laws concerning dog ownership? yes no

27. Are you willing to provide us with the follow up reports as needed? yes no

28. Who is your Veterinarian?

Name:

Address, City, State, ZIP:

Phone Number:

29. Please list 3 references (2 if you would like to count your Veterinarian). Please include complete names, addresses and telephone numbers:

a.

b.

c.

By submitting this application, I (we) authorize the Veterinarian listed on this application to release information to Timber Lane Shilohs.

Applicant's name: Date:

Any further questions and/or comments you may have can be included with this application. Please make your comments below:

 

If you would like to be added to our list for a puppy, a deposit of $250.00 will be required. Feel free to contact us for more information.

Thank you for your interest in Timber Lane Shilohs.