Heatwave Puppy Application

Please provide the following contact information:

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail
URL

FAMILY INFORMATION

Names, Relationship and ages of others in the household (Adults & Children):

OTHER PETS
Do you currently have any other pets? Yes, No
If "Yes" please list and describe your pet(s) as follows:
Name, Type, Age, Sex, Spayed/Neutered:
 		 If you answered 'yes' to owning other pets, please describe the current diet, supplements, etc. you are feeding your animal.

CURRENT VETERINARIAN INFORMATION
Name of Veterinary
 Address & Contact Information:

CURRENT RESIDENCE INFORMATION
Do you own or rent your home?
 		How long at current residence
Type of residence: Detached, Single Family Home, Townhouse, Duplex, Apartment, Condominium
 		 Any Plans of Moving? When? Where? Why?
Please tell us about your Yard: Fenced Yard, Unfenced, Patio/Deck only, No Yard.
 Please describe the approximate size of your
yard and the type of fencing (if applicable):

CANINE ACCOMMODATIONS
Will the dog live primarily inside or outside?
 		When the dog is outside, please describe the shelter it will have:

SCHEDULE INFORMATION
Will there be anyone home regularly during the day?, Yes, No
 		If "yes", approximately how many awake hours per day?

PAST DOG EXPERIENCE
Have you ever owned a dog (Yes or No)?
 		Please list breed of dogs, when you owned them and if you no longer have them, what happened to them?
Have you ever surrendered an animal to a shelter, given an animal away or sold an animal? Yes/No
 		If Yes, please describe the circumstances.

DOG RELATED INFORMATION
Please explain why you want a Heat Wave Puppy:
 		What type of canine training experience do you have? Puppy Kindergarten, Obedience Training, CGC, TDI, TT, SchH, PP, etc. (List all that apply)
Do you plan to crate train? Yes or No
 		Would you be able to pick up your Heat Wave puppy personally?
Do you have a trainer that you currently use or have used in the past?
 What is your purpose/goal for getting a Heat Wave Puppy? Show/Conformation, Breeding, Working, Sport of Personal Protection, General Family Protector, Companion (List all that apply)
What is your timeframe for getting a Heatwave Puppy? Immediately, Few Months, 1 Year, Just looking
 What activities will you and your Puppy be involved in? Agility, Conformation, Obedience, Puppy Kindergarten, Schutzhund, Sport of Personal Protection, Therapy Work, Tracking, Weight Pulling, Companion Only (List all that apply)
What type temperament are you looking for?
 Do you prefer a male or female? Male, Female, No Preference.
Do you plan to spay/neuter? Yes, No, Undecided
 Do you plan to crop the ears? Yes, No, Undecided. (N/A Akitas)

REFERENCES
Please supply names and telephone numbers of personal references, preferably individuals who are familiar with your care of animals:
 Please give us any other additional information about yourself that will help us determine the best puppy to match you and your family with. Also, you may tell us if you are interested in a puppy we have available or one of our upcoming breedings: Which breeding are you interested in?

VALIDATION

Please type your full name here. By doing so, you are giving us your e-signature that the above information is true and correct to the best of your knowledge. Your e-signature also authorizes us to contact any individual listed above and obtain information about you that could be regarded as confidential. This in no way binds us to sell you a dog, nor binds you to buy a dog. This is for informational purposes only.


Copyright © 1999 Heatwave Akitas & Cane Corso. All rights reserved.
Revised: 08/11/09