Your Full Name (*)

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Street Address (*)

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City (*)

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State (*)

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Zip Code (*)

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E-Mail Address (*)

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Home Telephone Number

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Mobile Telephone Number

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Gender Preference
MaleFemale
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Age Preference
<1 year1-2 years2-4 years4-6 years6+ years
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Do You Have any Pets? (*)
Cat(s)Male DogFemale DogExotic PetsNone
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Breed and Age of current pets

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Are your pets spayed/neutered?
Yes
No

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If you have dogs, are they currently on heartworm preventive?
Yes
No

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Describe any children in the home (age, gender, etc...)

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How many adults are in your home? What hours are they home?

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What hours will the dog stay alone? Where will it stay when no one is home?

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Where will the dog stay during the day? At night? While the family is on vacation?

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Do you rent or own your home?
RentOwn
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If rent, please provide contact info.for landlord.

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If your lawn is fenced, please describe the fencing. How high at its lowest point?

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I will allow a WCWR volunteer to conduct a home visit before receiving a Weimaraner (*)
Yes
No

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Why do you want a Weimaraner?

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Please provide your current / most recent veterinarian\'s contact information. If you are a first-time pet owner, please provide contact information for a personal reference. (*)

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Are you willing to take your Weimaraner to obedience training classes? (*)
Yes
No

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Additional Information or Comments

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How did you hear about WCWR?

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