Puppy Application

This is an application for a Lucky Jacks puppy. I am very careful with whom I place my puppies. This questionaire will help me in placing my puppies in responsible and loving homes. Please note: I DO NOT ship my puppies under any circumstances. You must pick up the puppy in person. Please mapquest Jacksonville N.C. from your location to be sure you are willing to travel BEFORE filling out this application. Also we only breed shorty's and smooth coats. Please make sure you completely fill out the application...questions with a * are required and the form will not send it to me if not complete. You should receive an automated email if your application was completed successfully. If you are not 100 % sure you want a puppy from us, just send us a simple email and we would be happy to answer any questions you have.

Thank you

Applicant Information

* First Name

* Last Name

* Address 1 (No P.O. Box's...physical address only)

* City

* State

* Postal Code

* Phone

* email

* Best Time to Contact

Housing/Landlord Info

* What type of home do you live in?

* Do you own or rent your home?

* If you rent, do you have your landlord's permission to own a dog?

Landlord's Name

Phone Number

Household Information

* How many adults in the household?

* How many children in the household?

* Age and gender of the children. If no children just type N/A.

* Are any members of you household allergic to animals?

* How many hours a day must your terrier be left alone? Where do you plan on keeping the puppy and how do you plan on keeping it safe & clean during this time.

* How would you describe your lifestyle?

* Do you have a fenced yard or kennel run? If so please describe (type, height, size)

* If no fence/kennel, how will you handle the dog's exercise/toilet needs?

Other Animal Information

* Do own any other dogs? If so, what breed & sex are they?

no

yes

* Are they spayed/neutered?

* Do you own any other animals? If yes, please describe.

no

yes

* How many dogs have you owned in the past 5 years?

* If you no longer own the dogs, please tell me what happened to them, please be specific.

Breed Specific Information

* Have you ever owned a Jack Russell before? If not briefly describe any research you have done and why you have chosen this breed.

yes

no

* Do you know what a Jack Russell was bred to do? If so, please explain.

* Where do you intend on keeping this dog primarily and where will he/she sleep?

indoors

outdoors

sleep

* What gender of Jack Russell are you looking for?

* Color preference?

* Which puppy or litter reservation are you interested in?

* What reasons are you looking to add a Jack into your life?

* What activities do you plan on doing with your Jack?

Veterinarian Information

* Do you have a veterinarian? (If no, skip this section)

Clinic Name

Vet Name

Street Address

City

State

Zip Code

Phone Number

* Please tell us where you found us! If a search engine, please tell us which one and the keywords you used!

Please list any additional comments or questions you may have here:

* Indicates Response Required