1)I/We have read the contract and agree to terms: No Yes 

 

2)What is your email address (this is so that I may reply): 

 

3) Name _____________________Spouse name_________________________ 

• Street address_____________________________ City______________________ 

State______ &__________ Zip County 

 Area code & phone# ________________________

4) Why do you want to adopt a chow chow?

5)Do you want your chow for (x beside all that apply) A) companion__ B) protection__
C) Guard dog__   D) Fighting__   E) showing__   F) obedience training/competition__
G)list your own reasons:

 

6)Do you have now or ever had other chows/dogs?____ If so, what kind and how many? ____
Please tell me thier names and ages when you aquired them, and ages if they haveleft you
and how they left you. (example passed away, or you found a new home for them/got rid of them)
Have you ever given a dog up of any breed?____ if yes please use space below to tell the
the reason.
 









7) If cat/dog, are they spayed/neutered? No Yes 
 

8) Including yourself, number people in your household? 

Relationship to you? include children and thier ages.

   


9)Is everyone in the household excited and commited about getting a chow chow 
and working together on care and training and grooming in a consistant manner____
Is anyone in the house scared of "dogs."_______
 

10) Are any members of your family home during the day? No Yes 

If so, who? 

11) Do you own or rent? Own Rent And you live in a: 

12) If renting, does your rental agreement permit you to keep a pet? No Yes 

If yes, landlord's name to verify. (or you can fax your rental agreement)

Area code & phone# 
13) If in an apt how do you plan to exercise/housebreak your puppy?



14) If you own or rent is the property fenced? No Yes  Completely enclosed? 

Fence type (chain link, stockade, etc.)? Height? 

Other details of yard? 

15) Where will pet be kept during the day? 
     At night?            When away overnight or on vacation? 

16) without going into too much private information
what is your Occupation. 

17) Your birth date 

18) If you can provide it, Work area code & phone# 

19) Work hours

20) Are other members of family employed?___ 
   if yes whom and occupation__________________________ 

21) Have you or anyone in your immediate family ever been convicted of cruelty to animals or any related 
charge? No Yes 

    Is any such charge currently pending? No Yes 

22) Please provide the following references: 

23) Name of veterinarian you most often use (if you don't currently have one, please start researching)


    Vet address Area code & phone# 

    Date of last visit 

    Please list at least 2 references and included name , phone number, and email address:

    


  


24)Tell me what you know about the Chow breeds characteristics:






Please use this space to write anything else you want me to know about yourself and why you and your family
would make great puppy parents. 

 

 

Thank you for your time to answer this questionaire. 

 

Carla Franchi 

www.Rhenegade-chows.com 

540 808 2484