Please complete all of the following questions:

Name:

Address:

City:

State:

Zip:


Phone number:


E-mail:


Type of home: House   Apartment

Do you have a fenced in yard?Yes   No

If no fenced yard, how do you plan to exercise your pet?


Do you own other pets? If so, what are they and how many?


What breed are you interested in?


What gender are you interested in?
Male   Female   Either

Are you interested in a particular coat color or eye color? If so please list:


Are you or have you ever been a breeder?Yes   No

If so, which breed/breeds were you involved with?


Are you interested in breeding quality or pet quality pup/dog?
Breed   Pet

Please let us know about yourself:


Would you be willing to adopt a retired breeding dog?Yes   No

Would you be willing to bring your pet for regular veterinarian visits and health screening (especially AKK owners)? Yes   No