Puppy Application

Puppy Application

Thank you for considering one of our puppies to add to your family, at Rebel Star we breed first and foremost for ourselves, but occasionally have puppies available to outside homes. Having been involved in rescue, we are very selective to whom we sell a dog to. If you would like to be considered for one of our puppies, please feel free to cut and paste this page to anemail, fill out the questionnaire and I will get back to you promptly.

Name:______

Address:______

Home Phone:______Work Phone:______

Best Time to Call:______E-Mail ______

Occupation:______

HOUSING / LANDLORD INFORMATION

Do you own or rent your home? ______

If you rent, do you have the landlord's permission to keep a dog? ______

Do you live in a: __House ___Apartment ___Townhouse ___Other:______

How long have you lived at this address? ______

FENCE / YARD / CRATE INFORMATION

Do you have a completely fenced yard suitable for a dog? ___yes ___no

Do you have a kennel run? ___yes ___no

Describe fence or kennel run - type, height and size: ______

______

If no fence or kennel run, how will you handle the terrier's exercise and toilet needs?

______

Do you have a suitable dog crate? ___yes ___no

If no, are you willing to purchase one? ___yes ___no

HOUSEHOLD INFORMATION

How many adults in the house hold? ______Children? ______

Age and gender of children: ______

Are any members of you household allergic to animals? ___yes ___no

Who in the household will have the main responsibility of caring for this pet?

______

How many hours a day must the terrier be alone? ______

Please describe your lifestyle: ____active ____ passive ____ in-between

OTHER ANIMAL INFORMATION

Do you own other dogs? ___yes ___no Spayed / Neutered? ___yes ___no

Please list breed, size, and gender of each:______

______

Do you own cats? ___yes ___no If yes, how many? ______

Any other animals? ____yes ____no If yes, please describe:______

______

How many dogs have you owned in the past five years? ______

If you do not still own the dog(s), please describe what happened to it (them). Please be specific.

______

Have you ever returned a pet to the breeder? ___yes ___no

If so, what were the circumstances? ______

______

Have you ever given a pet away? ___yes ___no If so what were the circumstances?

______

Have you ever taken a pet to the pound or shelter? ___yes ___no If so, what were the circumstances?

______

Have you owned a Jack Russell Terrier before? ___yes ___no

Why did you choose this breed? ______

______

Do you know what the JRT is bred to do? ___yes ___no If so what? ______

______

What activities do you plan on doing with this dog?

___pet ___guard ___hunting ___obedience ____Agility ___JRT Trials ___ other: ______

Will you be attending any training classes? ______

Do you plan on keeping this dog primarily? ___indoors ___outdoors

Where will dog sleep?______

Do you have a regular vet? ___yes ____no

Name: ______Phone:______

Address:______

PREFERENCES

At what age would you like to get the puppy? ______

SEX

I would like a ___female ___male ___no preference

COAT TYPE

I would prefer a: ___smooth __broken ___rough coat ___no preference

COLOR

I would prefer a: ___tri (black, tan & white) ___tan & white ___ black & white ___no preference

Have you considered an older dog instead of a puppy? ___yes ___no ___unsure

Do you plan on breeding this dog? ___yes ___no ___not sure

If so why?______

______

Thank you for investing this time in your search for a new puppy. Keep in mind that the above sexes, coat types and colors may not be available in this litter. It is only to give us an idea of what you are looking for, so that wemay help you better.