Name:               

Street Address:

Address Line 2 (Optional):

City:   State: AL AK AR AZ CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA MA MD ME MI MO MN MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VI VT WA WI WV WY  

ZIP: Home Phone#:

Work Phone # (optional):

E-Mail Address:  

Fax #:

What determined your choice of breed? Please, elaborate.

Which Gender would you prefer? 
Male      Female     No Preference

Why?

Age Preference of Dog:  Senior(7+)    Adult (2-6 years)      

   Puppy (0-2 years)            No Preference

           Why?

Color Preference: liver liver and white black black and white No preference

Have you ever Owned a GSP? 
Yes            No 

Do you currently own a GSP? 
Yes            No         

If yes, age and sex:

Do you have other pets? Yes        No

If yes, please describe (type, breed, age, sex, etc.):

Current or past veterinarian name, address, phone # (for reference):

How far would you travel for a dog?

Time limit in search for dog, if any?

Do you currently: 
Own your home        Rent your home 

Where will dog live and spend most of the day? 
inside and attended at work with me fenced yard kennel chained or tied up inside and unattended crated

Do you have a yard? 
Yes    No 

Size?

Fence? 
Yes    No 

Fence Type? chain link wooden stockade post and rail electric invisible other

Fence Height?

Someone home during the day?  yes      no

Amount of time dog would be left alone each day:  

Someone willing to take off work when dog first arrives?

yes              no