List information for each adult in the household. |
| First : |
Last : |
| Address:
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Street Address :
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| City:
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State:
Zip: |
| e-mail: |
| Telephone :
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Cell phone :
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| Employer:
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Work Telephone :
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| Occupation:
|
| Number of persons in household:
Adults:
children:
ages of children:
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| Do you have grandchildren?
No
Yes |
If so, what are their ages:
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| Does anyone in your home have allergies to dogs?
No
Yes |
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List the name, address, and telephone number, and relationship (friend, co-worker, neighbor, etc.) of two personal references who are NOT related to you by blood or marriage. |
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Home Information
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| Which best describes your home: |
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If Other, please describe: |
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| Is your home rented?
No
Yes |
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If rented, please complete the following section. We require a letter from your landlord stating that you have his/her permission to have a Saint Bernard on the rental property. Contact us for further instructions. |
| Landlord Contact Information |
| First : |
Last : |
| Telephone :
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Cell phone :
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| Address:
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Street Address :
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| City:
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State:
Zip: |
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| Do you have a fenced yard? |
No
Yes |
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| If Yes, what type of fencing do you have? |
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Height of fencing? |
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Length of fencing? |
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Width of fencing? |
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Pet Information |
Please list all veterinarians used and all pets owned in the last 5 years. |
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| Primary Veterinarian's Name: |
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| Veterinarian Hospital Name: |
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| Street Address: |
City: |
| State:
Zip:
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Telephone : |
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| Name and telephone number for all other veterinarians used in the last 5 years
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Total number of pets owned in the last 5 years: |
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Pet 1
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| Breed :
|
Gender:
Male
Female |
| Name :
|
Age :
year(s) |
| How long has (or did) this pet live with you? : |
years. |
| On monthly heartworm and flea/tick prevention? |
No
Yes |
| Up to date on all shots? :
No
Yes |
Spayed or Neutered?
No
Yes |
| Where is the pet now :
|
If deceased, at what age?
years. |
| |
Cause :
|
Pet 2
|
| Breed :
|
Gender:
Male
Female |
| Name :
|
Age :
year(s) |
| How long has (or did) this pet live with you? : |
years. |
| On monthly heartworm and flea/tick prevention? |
No
Yes |
| Up to date on all shots? :
No
Yes |
Spayed or Neutered?
No
Yes |
| Where is the pet now :
|
If deceased, at what age?
years. |
| |
Cause :
|
| |
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Pet 3
|
| Breed :
|
Gender:
Male
Female |
| Name :
|
Age :
year(s) |
| How long has (or did) this pet live with you? : |
years. |
| On monthly heartworm and flea/tick prevention? |
No
Yes |
| Up to date on all shots? :
No
Yes |
Spayed or Neutered?
No
Yes |
| Where is the pet now :
|
If deceased, at what age?
years. |
| |
Cause :
|
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Pet 4
|
| Breed :
|
Gender:
Male
Female |
| Name :
|
Age :
year(s) |
| How long has (or did) this pet live with you? : |
years. |
| On monthly heartworm and flea/tick prevention? |
No
Yes |
| Up to date on all shots? :
No
Yes |
Spayed or Neutered?
No
Yes |
| Where is the pet now :
|
If deceased, at what age?
years. |
| |
Cause :
|
| |
|
Pet 5
|
| Breed :
|
Gender:
Male
Female |
| Name :
|
Age :
year(s) |
| How long has (or did) this pet live with you? : |
years. |
| On monthly heartworm and flea/tick prevention? |
No
Yes |
| Up to date on all shots? :
No
Yes |
Spayed or Neutered?
No
Yes |
| Where is the pet now :
|
If deceased, at what age?
years. |
| |
Cause :
|
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If more than 5 please list the same information for the others:
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Are you aware that the veterinarian bills for a Saint Bernard may run between $100 - $500 per year? |
No
Yes |
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| If you own a pickup, will the dog ride in the back? |
No
Yes
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| Have you ever obedience-trained a Saint ? |
No
Yes |
| Another breed? |
No
Yes |
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| Who will feed and care for the dog? |
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| Where will you keep your pet |
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during the day? |
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at night? |
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| How many hours would the dog be alone on a typical day? |
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| Why do you want to adopt a Saint Bernard? (check all that apply) |