Puppy Placement Application For Blossom Valley Ranch

APPLICATION TO ADOPT/PURCHASE LAB PUPPY

Guardianship of another animal (you are one, too) is a major responsibility and a long-term commitment. You may share 10-15 years of your life with the puppy you adopt. In order for me to evaluate your suitability to be an adopter of one of my beloved puppies, you must be: (1) at least 18 years of age; and (2) able and willing to spend the time and money necessary to provide the proper day-to-day care, training, and veterinary care for the puppy you wish to adopt for its entire natural life.

Please answer the following questions and return in one of the following manners:

* Print the document, fill in the blanks, sign, and fax to me at 626-302-1935 (with a coversheet); or

* Save-as text document, type your answers in the spaces provided, and return the form to me as a text attachment to an email sent to: BVRanch@cox.net and gilliaa@sce.com

Name: _____________________________________________________________

Spouse/Partner: _____________________________________________________

Address: ___________________________________________________________

City: ___________________________ State: _________________ Zip: _______

Home phone: _______________________ Work phone: _____________________

How long have you lived at this address? ___________________________________

Your E-Mail address at home: ___________________________________________

Your E-Mail address at work: ____________________________________________

Your Age: ____________________ Age of Spouse/Partner: __________________

No. of Children: ______________ Ages of Children: _________________________

Others who reside in your home and ages:___________________________________

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Do any of the people in your home have allergies? No: _______ Yes: _______

If "yes," who are they? _________________________________________________

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Are any of the people in your home afraid of dogs? No: _______ Yes: _______

If "yes," who are they? _________________________________________________

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Do all members of your household want to get a dog? No: _______ Yes: _______

If "no," who does not? __________________________________________________

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Who will take primary care of and responsibility for the puppy? ___________________

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Who will be responsible for the puppy if something happens to you? _______________

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Do you own or rent your home? ________ Is it a house/apartment/condo? _________

Do you have screens on your windows? No: _______ Yes: _______

Do you have screen doors? No: _______ Yes: _______

If "yes," do the doors have strong automatic closing devices? No: _____ Yes: _____

Do you have a yard? No: _______ Yes: _______

If "yes," how big is it? __________________________________________________

Do you have a patio? No: _______ Yes: _______

If 'yes," how big is it? __________________________________________________

Do you have a fence? No: _______ Yes: _______

If "yes," then how high is it? ____ feet. What kind of material is it? _______________

Do you have a pool? No: _______ Yes: _______

If "yes," then is it fenced? ____ How hight? ____ What material? _____________

How did you learn about the Labrador Retriever breed?

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Have you owned a Lab before? No: _______ Yes: _______

Have you owned any other kinds of dogs before? No: _______ Yes: _______

Have you been around Labs before? No: _______ Yes: _______

If "yes," in what situations: _______________________________________________

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Do you want to show your puppy in AKC conformation events? No: _____ Yes: _____

Do you want to do field trial work? No: _____ Yes: _____

Do you want to take your puppy to AKC agility trials? No: _____ Yes: _____

Do you want to do obedience with your puppy? No: _____ Yes: _____

What sex of dog do you want? Male: ______ Female: ______ Either: ______

What color do you want?

Yellow: __ Black : __ Chocolate: __

Will you take the puppy you get to basic training? No: _____ Yes: _____

If "no," then why not? __________________________________________________

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Why do you want to have a dog? _________________________________________

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How many dogs have you had in your life? ______________

What kind(s), breeds, sexes, and ages were they? ____________________________

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What happened to the animals listed above, which are no longer with you (if one died, list

the cause of death)?

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How many dogs has your spouse/partner had in his/her life?

_____________

What kind(s), breeds, sexes, and ages were they? ___________________________

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What happened to the animals listed above, which are no longer with you (if one died, list

the cause of death)? __________________________________________________

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How many other kinds of animals do you have now? _______________________

What kind(s), breeds, sexes, and ages are they? _____________________________

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Have you ever spayed/neutered your animals? No: _______ Yes: _______

If "no," why not? ______________________________________________________

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Name, address, and phone number of your veterinarian reference: ________________

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Names, addresses, and phone numbers of three personal references who can vouch for your

humane treatment of animals:

(name #1) _________________________________________________________

(address) __________________________________________________________

(phone #) __________________________________________________________

(name #2) __________________________________________________________

(address) __________________________________________________________

(phone #) __________________________________________________________

(name #3) __________________________________________________________

(address) __________________________________________________________

(phone #) __________________________________________________________

What is your occupation? _______________________________________________

Give the name, address, phone number of and how long you have worked for your employer:

(name) ____________________________________________________________

(address) __________________________________________________________

(phone #) __________________________________________________________

(period of employment) _______________________________________________

What is your spouse/partner's occupation? _________________________________

Give the name, address, phone number of and how long your spouse/partner has worked

for her/his employer:

(name) ____________________________________________________________

(address) __________________________________________________________

(phone #) __________________________________________________________

(period of employment) _______________________________________________

How many hours are you away from home each day? ___

How many hours is your spouse/partner away from home each day? ___

Where will the puppy stay during the day? ___________________________________

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Where will the puppy sleep at night? _______________________________________

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How long do you plan to keep this puppy? __________________________________

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If you go away for a few days, who will care for the puppy? ______________________

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Under what circumstances would you surrender this puppy? _____________________

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Have you ever taken a dog to the animal shelter, humane society, pound, or other facility that

euthanizes animals? Yes _____ No _____

If "yes," why: _________________________________________________________

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If your puppy has an emergency or serious illness, what is the maximum you are willing or able

to spend on veterinary care?

None ___ $1-10 __ $11-50 __ $51-100 __ $101-500 __ $501-1,000 __ >$1,000 __

May I visit your home to see the puppy and how it is being cared for? ______________

How did you learn about Blossom Valley Ranch? _____________________________

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Comments: _________________________________________________________

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By typing my/our name(s) below, I/we agree that:

* my/our typed name(s) constitute(s) an electronic signature for legal purposes,

* the facts provided in this application are true and correct to the best of my/our knowledge,

* I/we realize that all such facts are material to the Breeder's decision to sell me/us a dog,

* any such fact that is not true will constitute legal misrepresentation in the formation of any Contract of Sale ("Contract") that results,

* such misrepresentation is grounds for the Breeder to immediately rescind any such Contract,

* Breeder may repossess the dog that is the subject of the Contract and retain all money paid for the dog, as liquidated damages, since damages for such misrepresentation are difficult to determine, prove, and calculate.

Applicant's Signature: __________________________________________________

Spouse/Partner's Signature: _____________________________________________

Date: __________ City/State where signed: ________________________________