Document Sample
					                                KINGSTONE REG’D GREAT DANES
                                       Puppy Application
                                               Kingstone Reg’d Great Danes
                                                C/o Sharon & Nikki King
                                                      P.O. Box 455
                                                  Beiseker AB T0M 0G0
                                                    Fax 403-947-2938

                            Please Note: Incomplete applications will not be assessed or considered.

   1.   Do you have a securely fenced yard?          Yes    No

        If yes, how high and what material is it made of?
        If no, do you have plans to build one before arrival of puppy or dog?       Yes         No

   2.   Do you have objections to us visiting your home prior to purchase?          Yes         No

   3.   Would you be willing to let us or a friend of ours come to visit the puppy or dog to see how it is working out in
        it's new home? Yes           No

   4.   Are you willing to attend puppy socialization and basic household obedience classes so it will become an
        enjoyable companion and good canine citizen?        Yes      No

        If yes, who would be responsible for the Great Dane’s training?

                                                   Applicant Information

Applicant 1:                                                                               Date:
               Last                                  First
Applicant 2:
               Last                                  First
               Street Address

               City                                                                        Province       Postal Code

Phone (Home):               (       )                        E-mail Address:
                                                             E-mail Address:

Phone (Bus):                (       )                        Phone (Cell):      (      )

Phone (Bus):                (       )                        Phone (Cell):      (      )

CKC # (if applicable):

                                        Internet Search       Great Dane Club of Canada            Other Dane Breeder
How did you hear about us?              Other
 Application for Adoption                                                                                    Page 1 of 4
                                                                          Family Companion         Show Dog
1.   What is the most important reason for purchasing a Great             Breeding Prospects       Therapy Dog
     Dane? Please check all that apply :                                  Obedience/Agility/Flyball Competition
2.   Have you owned a Great Dane in the past?
     If so, what was the name of the Breeder?                            Yes      No

                                                                           Yes    No
3.   If no, have you had exposure to the breed?                        if yes, where:

4.   Have you ever completed a CKC or AKC title?                          Conformation      Obedience
     Please check all that apply.                                         Field    Tracking   Agility

5.   Are you interested in putting any other titles on this puppy or           CGN (Canine Good Neighbour)
     dog? Check all that apply.                                                Agility    CD (Obedience)
                                                                               Rally Obedience

6.   Have you ever had a litter of puppies?
     If yes, please explain.                                             Yes      No

7.   If purchasing a puppy as a family companion and it is not
     going to be bred, do you agree to have it spayed/neutered by        Yes      No
     1 year of age and submit a veterinarian certificate to the
     breeder as proof of surgery for our records?
                                                                          House          Apartment        Farm
8.   What is your dwelling type:                                          Condo          Town House
9.   Do you own or rent your home:                                        Own            Rent
                                                                         Yes      No

5. If renting, does your lease agreement allow for                     Please provide the following information:
     Giant breed dogs within the premises?                             Landlord’s Name:
                                                                       Telephone: (       )

10. How long have you lived at this address?
11. If you are on a rural property, are you willing to properly          Yes      No
    enclose a suitably sized area for a Great Dane?
12. Do you have any relocation plans in the next 5 years?                Yes      No
13. In the event of a move, are you willing to include the Great
    Dane in your relocation plans?                                       Yes      No
14. In the event of a move, are you willing to advise us of your
    new address?                                                         Yes      No
15. When you go on vacation, what plans will be made to
    accommodate your Great Dane?
16. Do you have any experience housetraining a dog?                      Yes      No
17. Do you have any experience in basic obedience training?              Yes      No
18. Are you familiar with crate training principles?                     Yes      No
19. Are you willing to crate train if necessary?                         Yes   No
                                                                         Yes   No
20. Will the Great Dane be crated after the initial training period?   Comment:
21. On a regular day, how many hours will the Great Dane be left

22. Where is the primary residence of the Great Dane?                     Inside House          Outside       Garage
Application for Adoption                                                                                  Page 2 of 4
23. Where will the Great Dane be kept while you are away from
    home?                                                                  Inside House          Outside        Garage

                                                                          Dog         Cat      Livestock
24. Do you presently have any animals?                                    Caged Animal (bird, ferret etc)
Please note: Pot-Bellied pigs, or any other member of the pig family   Please specify:
               are instinctive prey for Great Danes!

25. If you currently have a dog, what age and breed?                   Dog 1:
                                                                       Age:        Breed:
Where did you get your dog from?        Breeder      SPCA              Reproductive Status:
  Pet Store Other:                                                        Neutered     Spayed         Intact
Name of Breeder :
Phone Number :
26. Other than current dogs, how many dogs have you owned in
    the past?
                                                                       Dog 1:
                                                                         Old Age     Ill – Humanely Euthanized
27. What happened to them?                                               Surrendered
                                                                       Dog 2:
                                                                         Old Age     Ill – Humanely Euthanized
                                                                       Dog 3:
                                                                         Old Age     Ill – Humanely Euthanized

28. Have you ever had to euthanize a puppy or dog other than
    for old age?                                                          Yes     No
    If yes, please explain :

29. How many family members reside in your household?

30. Are there people home during the day?                                 Yes     No

                                                                           Yes     No
31. Are there children living in the home?                             If yes, please provide number and ages:

32. Do any members of the family have allergies toward dogs?              Yes     No

33. Are all family members agreeable to the new puppy or dog?             Yes     No

34. Will each member of your family be available to meet an
    potential puppy?                                                      Yes     No

35. Do you agree not to let this dog ride in the back of an open
    vehicle?                                                              Yes     No

36. Do you agree never to tie this dog up as a means of                Yes      No
                                                                       Yes      No
37. Would you ever use an electric collar on this dog for the          If yes, please explain under what
    purpose of training?                                               circumstances
38. Is there anything else you would like us to consider that
    would assist us to determine a proper placement for you?

  Questions # 41 – 43 need only be answered if the puppy is being purchased for the purpose of Showing and /or Breeding.

Application for Adoption                                                                                    Page 3 of 4
  39. If purchasing a Show Quality Great Dane puppy, are you
      willing to show it or have us show it to his or her’s Canadian       Yes          No
      and/or American Championship?
  40. If puppy/dog is being placed in a show and/or breeding home          Yes          No
      and is not going to be spayed or neutered, we may choose to
      place these dogs on Co – Ownerships. Would this be a
      concern to you?
      If yes, please explain your concerns that you would have with
      a co-ownership.

  41. If this puppy/dog is bought for the purpose of showing and/or        Yes          No
      breeding and is found not to be of breeding and/or show
      quality, would you spay or neuter upon the request of the

                  (please list your veterinarian, one personal reference and one emergency contact)

Full Name:                                             Relationship:           Veterinarian

Company:                                                                           Phone:     (   )

Full Name:                                             Relationship:

Address:                                                Phone:             (        )

Full Name:                                              Relationship:

Address:                                                  Phone:       (       )

   I declare that I have read and understood the information on this application, and that all
   statements made with respect to this application are true and complete. I understand that
   misrepresentation, falsification, or the withholding of requested information with respect to this
   application can result in cancellation of this application, and, in the event I have received a Great
   Dane based upon false information, I agree to surrender the Great Dane back to Kingstone Great
   Danes without compensation.

   Date:                              Signature:         _________________________

                                        Signature:         _______________________

   Application for Adoption                                                                           Page 4 of 4

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