Von Miller Kennel Dog Adoption Application Form

Welcome! Thank you for inquiring about your dogs!

Please continue to fill out the form below. This application will take you about 15-20 minutes to complete once complete our staff will contact you with more details. We thank you again for your help in this amazing process! By filling out the form below you give authorization to Jeff Miller, Von Miller Kennels to review your application.

Full Name*

Occupation*

Street Address 1*

Street Address 2

Town / City*

State / Province*

Country

Postcode / Zip*

How long at this address?

Daytime Phone*

Evening Phone

Best time to call*

Email*

Family and Housing

How many adults are there in your family (their relationship to you)?*

How many children (ages)?*

What type of home do you live in single family, town home, apartment, farm, etc.?*

Please describe your household:*

Active

Noisy

Quiet

Average

Does anyone in the family have a known allergy to dogs?*

Is everyone in agreement with the decision to adopt a dog?*

Do you have time to provide adequate love and attention?*

Other Pets

What other pets do you have (specify type and number)?*

Veterinarian

Do you have a regular veterinarian?*

yes

no

Veterinarian’s Name

Clinic Name

Clinic Address

Clinic Phone

(Providing VMK with this information you are allowing VMK to call your vet. Please call your vet and ask them to authorize the release of information to VMK.)

About the dog you wish to adopt

What is your idea of an ideal dog and why?

Desired Age

Desired Size

Desired Breed

Number of hours (average) dog will spend alone?*

Who will have primary responsibility for this dog's daily care?

When the dog goes out, how do you plan to supervise it? Fenced yard?

How did you hear about Von Miller Kennels?

Separator

Message to Breeder*