Application

DIVINE SHIH TZU OF FAIRLAND

Ready to apply? Let's do this!

* Indicates required field

Name *

First

Last

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Color Preference *

Sex *

Male Female No Preference

Breeding Rights *

Full Limited None

Housing *

Own Rent

IF RENT ONLY- Landlord's name & phone number *

Please list any children in the home and their ages. *

Briefly describe your work schedule. *

Vet Name & number *

groomer name & Number *

Do we have permission to contact vet & groomer for reference? *

Yes No

If no, please explain. *

have you had to rehome a pet? If yes, why? *

Do you own any other pets? if yes, please list breeds. *

Are the other animals you own spayed/neutered? *

Yes No

In the event you can not keep the dog, you understand that you are contractually required to return him/her to us, the breeder? *

I agree I do not agree

Any questions or comments? *

Submit

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