Name *

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Vet Clinic Address

Please list the complete address of your primary vet. This is used for reference purposes.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Vet Clinic Phone *

Please list the phone number of your primary vet. This will be used for reference purposes.

(###)

###

####

Rental/Homeowners Insurance *

Do you have rental insurance, an umbrella policy or homeowners insurance? Every adopter is required to maintain an active renters policy and/or home owners insurance. Please note, that not all insurance policies will cover fostering, multiple dogs, etc. It is your expressed responsibility to ensure you are within the guidelines of your policies.

Yes, I agree.

No, I do not.

Personal Reference #1 *

This will be used for a personal reference. This reference should NOT be a family member or anyone residing in your home.

First Name

Last Name

Personal Reference #1 *

Phone number for your first personal reference.

(###)

###

####

Personal Reference #2 *

This will be used for a personal reference. This reference should NOT be a family member or anyone residing in your home.

First Name

Last Name

Personal Reference #2 *

Phone number for your second reference.

(###)

###

####

Home Check *

I agree to have a home check conducted to evaluate my home for the safety and well-being of the weimaraner(s) I am interested in adopting.

Yes

No

Today's Date *

MM

DD

YYYY