99 Jody Jones Road

                                             Whitley City, Kentucky 42653

                                                      (606) 310-3948



Home Phone:_________________________________

Work Phone:_________________________________



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,

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:__________________________________________
Work Phone:___________________________________


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.

Phone Number:

Phone Number:

Phone Number:

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