First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Cell Phone*

DOB*

Which LOAR animal are you interested in?*
Choose an animal: ***Kitten Special 2 for $200 ***Not on List/Unsure - Cat ***Not on List/Unsure - Dog Bart @ The Cat's Brew Brendal Buck @ The Cat's Brew Cleo Coconut Cooper @ The Cat's Brew Deanna Dixie @ The Cat's Brew Dubai Eleanor Frank @ The Cat's Brew Freddy Fynlee @ The Cat's Brew Garth Harper Hayes Heidi Lenny @ The Cat's Brew London Louise Malibu Miranda Nyx Oslo Paris Pecan *Special Needs* Rex Ripp Rome Rose Schoochie Sydney Taz Thelma Vienna Vince @ The Cat's Brew

Please list the full names and birthdays of any other adults living in your home.

Do you own or rent your home?*
Choose one: Rent Own

If you rent, please enter your landlord's name, the complex name, and phone number.*

Will the dog be kept inside or outside?* *
Choose one: Inside Only Outside Only Inside and Outside

My experience with dogs includes (check all that apply)

My dog needs to be friendly with children

Is your yard fenced?*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

Where will the dog be kept when you are home? Please describe this area.*

My new dog must get along with

Please tell us about the pets you have now and in the past. Include name, breed, gender, spayed/neutered, vaccinations, still owned by you or where is the animal now?*

If your current or previous pets are or were NOT spayed or neutered, please explain the reason(s).*

Please provide the name and phone number of your current and/or previous Veterinarian(s).*

May we contact your Veterinarian as a reference?*
Choose one: Yes No N/A

List at least two references (who are not family members) AND provide their phone numbers.*

Have you ever given up a pet? If yes, please explain*