1. Name .............................................................................................
2. Email Address and Phone Number .........................................
3. Why do you want a Dog?..........................................................
4. Why a Shih Tzu/Imperial Shih Tzu?....................................
5. Are you 18 years old or older?
6. Do you;
7. Do you live in a;
8. If renting, do you have permission from your landlord?
9. Can you provide written confirmation of this?
10. Please list all household members and their ages..................
11. For whom are you adopting this puppy?
12. Who will be primarily responsible for the care and supervision of the puppy?
13. Do you plan on supervising small children at all times around this puppy?
14. What will happen to this puppy/dog if you move?
15. Do you have other pets?
16. If yes please list what kind and their ages....
17. Do you have a regular vet for your animal(s)?
18. Are your current pets up to date on their vaccinations?
19. If you do not currently have pets, have you ever had pets as an adult?
20. If yes, what kind and what breed?
20. If you have had pets, but no longer have them, what happened to them?
21. How many hours a day will your dog be left alone?
22. How will the dog be confined when left alone or unsupervised?
23. ALL DOGS/PUPPIES ARE SOLD WITH LIMITED AKC REGISTRATION. ARE YOU PREPARED TO SPAY/NEUTER YOUR PUPPY AT THE AGE OF 5 TO 6 MONTHS OLD?
24. Do you have a fenced yard? What kind of fencing?
25. Is this dog/puppy going to be a primarily;
I CERTIFY THAT THE ABOVE IS TRUE. I agree that Diana Davidson of Lil' Darlin's Imperial Shih Tzu will be notified first if I am no longer able to keep my dog for any reason. This dog will never be sold or turned over to a pet shop, laboratory, auction, wholesaler, dog pound or humane society. Diana Davidson can/ will care for the dog until a new home can be found if necessary.
Typed Signature Date: