Form Title

Date

MM
/
DD
/
YYYY
Name

First

Last
Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone Number

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Email
People in household and ages of children
Other pets in household?
Does anyone in this household smoke?
 NO 
 YES 
Have you ever had a dog? What Kind?
Age and cause of death
Why choose a Labrador?
Do you have a fenced in yard?
Do you own a crate?
Will you do puppy kindergarden?
Is anyone home during the day? If not who will
take care of the pup when you are not home
Where will the dog sleep?
Are you an active "on the go" family or more
mellow stay at home. Tell me the family
activities. Tell me what your expectations are in
this new family member.
What is your color preference
 Black 
 Yellow 
 Chocolate 
 No Preference 
Sex Preference
 Male 
 Female 
 No Preference 
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