Your name:        _______________________________________________
Address:                                                                                                           

How many years at this address?                  Own or Rent?                         

Phone:                                               Cell:                                                 

Email address:                                                                                          

Date of application:                                                           

Are you interested in a Male or Female?                             

Are you looking for cropped or natural eared?                            

Are you looking for a show puppy or companion pet?                            

What color Great Dane are you interested in?     

1.                              2.                             3.                            

Primary Caregiver:                                                                                    

Secondary Caregiver:                                                                                

Primary Caregiver Occupation:                                                                   

Bus. Name:                                                        Bus. Phone:                               

How many years have you worked for this business?                                   

List work schedule                                                                                                                                                                                                    

Do you travel for your job?                                        How 0ften?                     

Secondary Caregiver Occupation:                                                               

Bus. Name:                                                Bus. Phone:                                       

List work schedule                                                                                                                                                                                                    

Do you travel for your job?                                        How Often?                     

Do you have any children?          If so, list their ages                                                                                                                                                 
If none, are you planning children in the future?                                         

Is anyone in your home allergic to pets?                                                     

Have you ever owned or lived with a Great Dane?                                        

Do you currently have any pets?                                 If so, please list their type or breed and age.                                                                                                                                                                                          

Have you ever turned a dog or cat into rescue?                   If so, when and why?                                                                                                                                                                                                                                                                                                                                        

Have you ever rescued a dog or cat?                                                          

Have you ever bred a litter?                                                                      

Who is your vet?        Please list name and contact phone number.

Is this a 24-hour facility?                                                                         

If not, where will you go in case of an emergency?  Please list name and distance from your home.

Are you familiar with Bloat?                                                                      

Where will you keep your new Dane?                                                          

Where will your new Dane sleep?                                                                       

Are you planning to crate your new Dane?                                                  

Is your yard fenced in?                                                                             

How much time do you anticipate that the dog will be outside each day?        

During vacation - who will care for your new Dane?      Explain

Where will you attend obedience class?                                                                                                                                                                      

Have you taken classes from this instructor?                                              

If so, list all your completed obedience classes (i.e. puppy class, basic etc.)?

Have you earned a Canine Good Citizen (CGC) and/or Therapy Dog (TDI) certification with your dog?                                                                  

Have you ever competed in Conformation, Obedience or Agility?                   

If so, explain                                                                                                                                                                                                            

List references name and phone (i.e. veterinarian, obedience instructor…etc.)