RUBY'S WEIMARANERS

                                                   99 Jody Jones Road

                                             Whitley City, Kentucky 42653

                                                      (606) 310-3948



Name:____________________________________________

Address:____________________________________________________________________________

Home Phone:_________________________________

Work Phone:_________________________________

Cell:_______________________________________

Email:______________________________________



How long have you lived at your current address?_____________________________

Which of the following best describes your current residence?         Own a single family home     Rent/Lease a single
family home       Own a townhouse/condo     Rent/Lease a townhouse/condo/apartment          Other

If you rent or lease, is your landlord agreeable to your owning a dog?   Yes      No

Your Yard:

Is your back yard completely and securely fenced?      Yes     No
If not, could you please explain how you plan to exercise your dog and allow it to relieve itself?
___________________________________________________________________________________________
If you have a pool, is it fenced?      Yes      No

Pet Ownership

Why do you want a dog?_______________________________________________________________________
Have you ever owned a dog before?     Yes      No
Please list all the animals that currently live in your household.Type/Breed/Sex:
______________________________________________________________
______________________________________________________________
______________________________________________________________
Please list any dog you have owned in the past and explain what happened to it, include, Type, Breed, Sex, Age, Years,
Dates:_____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Care & Responsibility

Is someone normally at home most of the day?      Yes      No
How much time would you have to spend with your Weimaraner?     Normal Workday?_____________________
                                                                                                     Normal Free Day?_____________________
Where will your Weimaraner spend the day?     Loose Indoors     Basement     Crate      Garage     Kennel Run ;Loose
Outdoors in Fenced Yard     Tied up Outside     Other (please list)
________________________________________________________________________________________

Will there be some protection from the elements when outside?     Yes     No
Where will the dog sleep at night? (Please be specific)______________________________________________
Do you have a Veterinarian you have used before and plan to use with your next dog?     Yes     No
Veterinarian Name:__________________________________________
Clinic:Location:_____________________________________________
Work Phone:___________________________________

References

Please provide three names as references, including your Landlord(if you rent your home), Veterinarian, Groomer, or
Dog Trainer (if you have one). If you belong to a Dog Club or any Dog-related Group, include the name of an officer or
associate. Other references could include a neighbor, your employer, a friend,or relative.

Name:
Phone Number:
Relationship:

Name:
Phone Number:
Relationship:

Name:
Phone Number:
Relationship:


All of the information I have provided in the questionnaire is true and complete to the best of my knowledge.


________________________________________________                        _______________________
                Signature of Applicant                                                                        Date of Application