Today's Date:

First Name:				Last Name: 
Street Address : 
City:				State:		ZIP:
Home Phone:          				FAX:
Email address:
Work Phone: 
Drivers License Number:

Your occupation:
Name of current employer: 
How long have been with this employer? 

What is your spouses name? 
What is your spouse's occupation? 
What is your spouse's work phone number? 

Names and Ages of others in your household:
Name				Age

Have you ever owned pets before? 

What Dogs or Cats do you currently own?
Species	Sex	Age   Is the pet spayed or neutered?  If "no", why?

If you haven't owned a dog before, why do you want one now?

Specifically, why do you want to adopt a Bullmastiff?

Have you ever owned a Bullmastiff before? 

Describe how you have educated your self about the Bullmastiff 
Breed:

Do you prefer a male, female or have no preference? 
What age range of dog are you looking for? 
What is your first color preference? 
What is your second color preference? 
Would you consider other Bullmastiffs? 

Are you willing to pay to ship a dog? 
How many miles are you willing to drive to pick up a dog? 

Do you own or rent your home? 
Does your landlord or home owners association give permission 
to keep a dog? 
If so, can you provide us with proof of that permission? 
How long have you lived at your current address?

Where will you keep the dog during the day time? 

Where will you keep the dog at night? 

How will you take care of the dog during overnight family 
absences? 

Do you have a fenced yard? 
If "yes",  the describe the type of fence:

How tall is the fence? 

If you do not have a fence ...
... how will you exercise the dog? 

... how will you confine the dog? 

... how will you provide his need for elimination? 

How many hours a day to you estimate the dog will be alone? 

Where will the dog spend his time when alone? 

Do you object to the discriminate use of a crate? 

Do you have a crate? 

Would you get a crate? 

What will you do if your dog is destructive when alone? 

Are you willing to attend obedience class with your dog? 

Have you ever surrendered a pet of yours to an animal shelter? 
... if "yes", why?

Have you ever sold or given away one of your pets? 
... if "yes", why? 

Have you ever trained a dog before? 
... if "yes" describe the training 

Can you afford to spend at least (if not more) $500 per year for 
food and medical care for your pet? 

Has anyone in your immediate family or household ever been 
convicted of a charge related to cruelty to animals or child 
abuse? 

Are there any such charges pending now? 
Has any such charge ever been filed? 
If "yes" to any of the above, please explain and give a 
disposition of the charge 

Who is or will be your regular veterinarian? 
Name
Street Address
City				State		Zip			
Phone 

List Two personal, non family references
Name   					Phone
1.
2.

Who is you nearest living relative? 
Name
Street Address
City				State		Zip			
Phone

What are the requirements for dog ownership in your 
community? 

How many pets can you legally have? 
Are dogs required to be vaccinated against rabies? 
Is there a leash law? 

What will you do with the dog if you have to move? 

Is anyone in the house allergic to dogs? 
How much time, per day, will you spend with your dog? 

What specific dog food will you feed? 

Additional Comments: