Your Name (required)

Full Address Including City/State (required)

Home Phone (required)

Mobile Phone (required)

Your Email (required)

Were you referred to us? If so, by whom? (required)

Have you read and do you agree with our adoption process? (required)
YesNo

Are you aware that the deposit is non-refundable? (required)
YesNo

Regarding your property, do you (required)
OwnRent or Lease

If you rent/lease, does your lease and/or landlord allow you to have dogs? (required)
YesNoN/A

If so, please provide the name and contact number for your agent/landlord (required)

Does anyone in your family suffer from pet related allergies? (required)
YesNoUnsure

Are you interested in our allergy agreement? (required)
YesNoI'd Like To Learn More About It

Do you own any other pets?(required)
YesNo

If so what type? (required)
CatDogOther

Please tell us about your pet

May we contact your Veterinarian? (required)
YesNoN/A

If so, please provide a telephone number

What do you find most appealing about the Havanese breed? (required)

Do You Prefer? (required)
MaleFemaleNo Preference

Are you willing to take the time to housebreak, socialize and train your puppy?(required)
YesNo

Are you interested in breeding your Havanese? (required)
YesNoUnsure

If so, what is your experience?

If you want to breed, are you able to commit to showing your Havanese in conformation shows?
YesNo

If you want to breed, are you able to commit to health testing your dog prior to breeding and annually?
YesNo

How many hours per day will your puppy be left alone? (required)

Are you open to a relationship with us? Are you willing to update us periodically regarding the development of your puppy? (required)
YesNo

Who will care for your puppy in your absence? (required)

Do you mind if we were to contact you periodically or send you informational emails in the future and after you bring your puppy home? (required)
YesNo

Are you aware of the hereditary diseases sometimes found in the Havanese breed? (required)
YesNoI would like to learn more

Tell us how you would discipline your puppy if you were to return home and find that the puppy had chewed your favorite pair of shoes? (required)

Please feel free to share any additional information about you and your family