Non-Bulldog Application

Application Date*
MM slash DD slash YYYY
This section provides us with information about the residence that your Bulldog will be calling home.
Applicant Name*
First Last
Age*
Physical Address*
Street Address Address Line 2 City State ZIP Code
Main Phone*
Cell Phone (If Not Main Phone)
Applicant - Place of Employment*
Length of Employment*
Is there a Co-Applicant residing at the same address?*
- No
- Yes

Co-Applicant Name (if any)
First Last
Age
Co-Applicant - Place of Employment
Length of Employment

In What Type Of Home Do You Reside?*
Please answer one of the following*
- I own my residence
- I rent my residence
How Many Years At Your Current Residence?*
If less than one year at your current address please list your previous address
Street Address Address Line 2 City State ZIP Code
Do you have a fenced yard?*
- Yes
- No
Please describe height and material of the fence.

Who would be responsible for the dog's care?*
Who would be responsible for the cost of care for this pet?*
Would you like information on pet insurance?*
- Yes
- No
How would the dog be exercised?*
Please list most recent and/or primary veterinary clinic*
If this is a clinic that you have used for less than a year please list previous veterinary clinic with phone and address. You must call the clinic/clinics to give permission to release information in order for them to speak with me.
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Please list three personal references with email addresses. (Hidden/OLD)
This makes it easier and less intrusive for me to reach them. Be sure to alert them that they will be contacted.
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Please list three personal references with email addresses (Hidden/OLD)
We prefer non-relatives and people who have frequented your home and are firsthand aware of the care that you provide your animals, past and present. These must be email addresses (no phone numbers).
Name Email Address
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Reference #2
Name Email Address
This field is hidden when viewing the form
Reference #3
Name Email Address
Please list three personal references with email addresses*
We prefer non-relatives and people who have frequented your home and are firsthand aware of the care that you provide your animals, past and present. These must be email addresses (no phone numbers).
First Last
Reference #1 Email Address*
Reference #2 Name*
First Last
Reference #2 Email Address*
Reference #3 Name*
First Last
Reference #3 Email Address*
Have you ever surrendered an animal to Animal Control, a rescue, or a shelter?*
- Yes
- No
If yes, please describe the circumstances under which this was done
Have you ever been charged with animal abuse or neglect?*
- Yes
- No
If yes, in what state? Date? And describe the circumstances.

Electronic Signature*
(type your name as you would sign it)
Electronic Signature Agreement. By selecting the "Submit" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "Submit" you consent to be legally bound by this Agreement's terms and conditions.
Email*

This email address will be used to send you a confirmation that we have received your request.
Name
This field is for validation purposes and should be left unchanged.

Non-Bulldog Application

Non-Bulldog Adoption Application For All Other Breeds

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