Jan Hammond      PO Box 145     Indian Hills Co  80454

It is our goal to place puppies in homes were they will thrive. Our questions are designed to help place the right pup with

the right owner. By taking a few minutes to answer our questions, you will help us know you better and determine if we

have the right pup for you. If you need more space to answer all the questions please either use the back or another piece of paper

today’s date:_________________________________________________________________________________________________________

applicants name: ________________________________________________________________________________________________________________________________

Spouse/roommate(s) names: _____________________________________________________________________________________________________________________

Street address :__________________________________________________________________________________________________________________________________

city:________________________________________________________________________________________________________ state: _________ zip: _________________

email address:___________________________________________________________________________________________________________________________________

home phone: ______________________________________________________ work phone: _________________________________________________________________

how many children are in the home? ___________ ages _______________________________________________________________________________________________

if no children, when and where will the akita come into contact with children? Please explain ______________________________________________________________

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are there other animals in the household? ___________ If yes, how many, what type (dogs, cats, birds etc)_________________________________________________

what are the breeds ages and sex of any other dog(s)_________________________________________________________________________________________________

______________________________________________________did you acquire any from breeders? From whom _______________________________________________

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have you ever owned and akita? ____________ if no, what has attracted you to the breed?_________________________________________________________________

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are you interested in showing /working your akita in any competitive manner (conformation, obedience, agility, tracking,
canine good citizen, therapy, etc. ) please explain: ______________________________________________________________________________________________________

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are you a member of any dog /akita clubs ? Please name________________________________________________________________________________________________

what traits are you looking for in an akita (temperament, size, structure, color, )_____________________________________________________________________________

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What characteristics do you NOT want in an Akita? _______________________________________________________________________________________________________

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What do you know about the Akita and it’s temperament traits? ____________________________________________________________________________________________

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How would you deal with an issue of dominance or aggression towards other animals in the home?_____________________________________________________________

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If with training, there were continued problems, would you place the Akita, return it to the breeder or separate the animals to alleviate the problem? _________________

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do you understand that the average life span of an akita is 10 to 12 years: ___________________________________________________________________________________

are you willing to care for this Akita for its lifetime ? _______________________________________________________________________________________________________

have you ever raised a puppy before? __________________________________________________________________________________________________________________

have you ever obedience trained a dog before and are you willing to train this pup ___________________________________________________________________________

where will your akita spend most of it’s time: daytime ___________________________________________nighttime ___________________________________________________

how many hours a day (approx) will your Akita be left alone ?_______________________________________________________________________________________________

have you ever returned and animal to the breeder? (yes) (no) if yes, please explain circumstance _______________________________________________________________

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Do you own or rent your residence?________________ Is this a house, Condo, apartment, etc.___________________________________________________________________

If you rent, could you provide a letter from your landlord for the approval of an Akita (yes) or (No)

If you own your home, do you have an association and dose the association have any canine restrictions?________________________________________________________

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Have you checked with your homeowners insurance to verify they will continue coverage if you acquire an Akita? ______________ who is your insurance

 carrier?_________________________________________________________________________________________________________________________________________________

Why are you interested in a Crazy Bear akita? ________________________________________________________________________________________________________________

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Do you have any questions for us __________________________________________________________________________________________________________________________

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PLEASE GIVE 3 REVERENCES Including phone number (one your veterinarian )

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Will you allow a home visit either by us or someone representative of us?____________________________

Thanks You for your interest in our Akitas

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signature of applicant

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signature of spouse/roommate

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signature of roommate