Puppy Interest

Prospective Jack Russell Puppy Owner
Application

*Full Name:

*Mailing Address:

*Street Address:

*City:

*State:

*Zip:

*Email:

*Cell Number:

Please describe your experience (if any) with Jack Russell Terriers:

*I prefer (check all that apply): Female Male Either Sex Smooth coat Rough/Broken coat Any coat	Do you have a fenced yard? Yes No No, but under construction If yes, what type of fence and how tall:

*Do you have small children? Yes No Yes, but they are familiar with animals If yes, ages:	*Type of living area: Home Apartment Condo

*Do you have cats? No Yes, and it runs from dogs Yes, but it is dog-savvy	How many other dogs do you have? None 1-2 3+ If yes, what breeds and sex, indicate dogs spayed/neutered

*How would you get your dog home? Pick up in person Ship by air Ship by ground	*Do you have livestock or poultry? Yes No

Would you be interested in an older Jack Russell? Yes No If yes, what are your requirements?

*What is your veterinarian's name and phone number?:

If interested please contact Lynn Hawley.

Forget-Me-Not Terriers, Lynn Hawley, Emmett, ID
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