Your Name: 

Your Occupation: 

Your City/State and Zip: 

Home Phone: 

Email Address:   
Please note, this is how we will be contacting you!

Do you own or rent your residence?  If you rent, do you have the landlord's permission to keep a dog?

Do you live in a house, apartment, trailer or other?  How long have you lived at this address?

Do you have a fenced yard? 

How many adults are in the household?  How many children?  What are their ages and sex?

Do you own other dogs?  Give breed, age and sex of each.  Are they spayed/neutered?

How many dogs have you owned in the past 15 years?  What happened to them?  Be specific.

Have you owned a Bichon before?  

List your plans for this Bichon:  pet, show, obedience, agility, other? 

If you have ever had a Bichon before,?  If yes, please tell us about the dog.

What is the number of hours each day that you will be away from home?

Where will the dog spend the day in your absence?

Where will the dog spend the night?

Where will the dog stay if you are out of town?

Puppy gender preference: 

Why do you want a Bichon?

What do you know about Bichons?

Tell me a bit about yourself and why you would be a good home for a Bichon.