HINZ-N-CO HAVANESE
Susan Hines
2206 Springdale Dr., SW
Hartselle, AL 35640
256.303.8258
APPLICANT INFORMATION: Date of Application:
Name of Applicant: Home Phone:
Address: E-mail Address:
City, State, Zip code: _ Referred By:
HOUSEHOLD MAKEUP: Provide the following information for all members (full or part-time) of your household.
|
Name
|
Relationship
|
Age
|
Home FT or Work Schedule
|
|
|
Applicant
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
List all pets that are currently part of your household.
|
Name
|
Type / Breed
|
Age
|
Indoor / Outdoor
|
M / F
|
Spayed / Neutered
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
PREFERENCES OF ADOPTIVE FAMILY
Male or Female: Color: Age:
Show Prospect: Any Show experience? ___________________________
Pet Only: Either:
If you decide on a pet Havanese, are you aware that it will be sold with limited registration on a spay/neuter agreement?
Timing - When would you like to add a dog to your family?
If there is not a dog available then, would you like to be placed on a waiting list? Yes No
Any other preferences?
ENVIRONMENT:
Will this dog be primarily an indoor or outdoor dog?
On average, how many hours will this dog be alone during the day?
How will this dog be confined outdoors (i.e. fenced yard, kennel, cable run, tether)? What is the size of the area?
Do you have an inground or above ground swimming pool? Yes No
If yes, is it fenced separately for the rest of the yard? Yes No
Once trained, how and where will this dog be confined indoors when no one is home (i.e. crate, gates, doors, none)? What is the size of the area?
Who will be the primary caregiver for this dog? _______________________________________________________
MISCELLANEOUS
Do you belong to a kennel club? _________________________________________________________________
Are you aware of the possible illnesses associated with this breed? ___________
How did you become introduced to this breed and what characteristics do you find the most appealing?
Please list the dogs that you have owned in the past.
|
Breed of Dog
|
Owned from (date) to (date)
|
Age of dog
|
What happen to him
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
List the types of training in which you have ever participated (i.e. puppy class, obedience, agility, flyball, none).
REFERENCES (Veterinarians, dog training instructors, friends, relatives):
|
Name
|
Relationship
|
Known for how long
|
Telephone Number
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Other comments or information:
Applicant’s Signature: Date:
 | 
