Date:
Name: Phone:
Address:
Email:
Number of adults and ages of children in the home:
Occupation(s):
Is one adult at home during the day? Yes No
Details:
Is your property owned or rented? Owned Rented
Is your yard fenced and secure? Yes No
Are you prepared for the dog to live in the house as a member of the family? Yes No
Would you have any out of bound areas for the dog? Yes No
Have you had any experience with dogs or training? Yes No
Are there any pets in your home? Yes No
Do you have any preference to the breed or sex of the dog? Yes No
When are you available to board a dog? (week-days or week-ends):
What age of dog are you willing to take? (puppy or adult) :
Why is it you would like to take part in our boarding home program?:
Please indicate specific times or days that you are not available for boarding:
Relationship: Years Known:
Comments/Notes:
