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| Was`te Kola Great Danes 636-285-1574 |

| Name * |
| Phone * |
| Address * Street, City, State |
| Email * |
| Employer |
| Including yourself, how many are in your family? |
| Where will the dog be during this time? |
| How many hours each day will the dog be left alone? |
| If not, how will you take care of the dog when it is outside? |
| Have you ever surrendered a pet to a humane society or any shelter? |
| If any are children, what are their sex and ages? |
| If so, is it fenced? |
| Why would you like to add a Great Dane to your family at this time? |
| Is there a yard? |
| In what type of dwelling do you live? |
| Do you plan to take your dog to training classes? |
| Have you read Responsible Guardianship? |
| Do you know what gastric torsion and bloat are? |
| If so, why? |
| Have you ever had a pet euthanized? |
| If so, why? |
| Where will the dog sleep at night? |
| Are you interested in a companion only, or breeding, conformation, obedience, other? |
| What qualities are you looking for in a dog? |
| How much time each day will you have to devote to the dog? |
| If so, what types and ages? |
| Spouse's Employer |
| Do you have any other pets? |
| Spouse's Name |
| Name of reference |
| Is there any thing else that you would like to add at this time? |
| * Denotes required information |