Name

Email Address

Address

City

State

Zip Code

Mobile Phone Number

Work Phone Number

Facebook profile (Paste link here)

Preferred Gender of Pup? Preferred Gender of Pup?MaleFemale

Number of members in your family? Number of members in your family?12345678910+

Do you have children? (Please include ages)

Any pet allergies in your family? Any pet allergies in your family?YesNoVery Minor

Do you live in a house or apartment? Do you live in a house or apartment?HouseApartment

Do you own your own home or do you rent? Do you own your own home or do you rent?OwnRent

Does your landlord allow dogs? Does your landlord allow dogs?YesNoNo, but I'm moving.

Have you owned a dog before? Have you owned a dog before?YesNo

What breed/type did you own?

What happened to your past dogs?

Do you have pets? What age?

Is your current dog acceptant of a new dog?

How did you decide on a Belgian Malinois?

Have you researched or owned this breed?

Why do you want a puppy?

Do you agree that if at any time you are unable to keep your puppy or dog, for whatever reason, you will need to return the puppy/dog to Michelle’s Malinois Kennels and we will place him/her in a suitable home?

Where will your dog live? Sleep? Eat? Play?

Do you have a fenced place for a dog? Do you have a fenced place for a dog?YesNo

If not, are you willing to construct one of these before puppy comes to live with you?

Do you understand that Belgian Malinois thrive on human attention and cannot be isolated from the rest of the family?

Do you understand that a puppy purchased from us must be a part of the family and not be a dog that lives outdoors all the time?

What Veterinarian do you plan to use? (Name, address, & phone number)

How do you plan on house-training?

Who will be the dogs primary handler?

What do you expect to do with your puppy? What do you expect to do with your puppy? Family PetPersonal ProtectionCompetition/Sport

Briefly tell us about your family’s lifestyle, hobbies, and interests

Briefly tell us the attributes you would like your puppy/dog to possess

Will you spay/neuter your puppy? Will you spay/neuter your puppy?YesNo

How did you hear about us?

Do you agree to all the conditions and state that the information provided by you is accurate and true?