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Online Puppy Application Form

Name of Applicant: 
Address:
City: State: Zip:
Home Phone:
Email Address:
Referred By:
 

HOUSEHOLD MAKEUP: Provide the following info. on all members (full or part-time) of your household.
 
NAME Relationship Age Home FT or Work Schedule
Applicant


List Pets:
  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?  Yes  No 
 
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?   Hours
 
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 in-ground or above ground swimming pool?  Yes    No   Which?    
 
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? YesNo
Please explain a little what you know about them (if yes):
 
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 happened to the dog?


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:   
 
 
Electronic signature required:
Review the form above, then sign electronically by typing your name in the field provided below.  By clicking, you agree that your typed name is your binding electronic signature. The date and time that the document is signed and tracked, IP address, is transmitted and stored on computers of Hinz N Co Havanese. Your data will not be shared with a third party company.  If you don't wish to sign, please print and mail via postal service.

 Signature:    Date:  

Thank you for your interest in obtaining a Hinz-N-Co Havanese puppy.  

Printable Puppy Application