| Applicant's Name and Address and phone numbers:: |
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| Email Address:: |
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| How were you referred to us?: |
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| How many adults are in your household?: |
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| How many children?: |
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| Please list the ages of children.: |
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| Is anyone at home during the day to care for the pup? If not, can someone exercise and feed the pup midday?: |
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| Do you have a fenced yard? If so what is the height and type of fence? If not, are you willing to either fence or to put up a suitable kennel for your dog?: |
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| Do you currently own any other pets? If so, please list them.: |
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| Have you previously owned other dogs? Please list them.: |
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| What is your primary reason for wanting an Akita?: |
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| Will this puppy be a companion, show prospect or combination? Obedience/Agility prospect?: |
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| Where will your dog live? House? Kennel run? Both? Other [describe]?: |
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| Do all family members want a new puppy? yes or no: |
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Would you consider a long coat?
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| Who will be the primary trainer/care giver for this puppy?: |
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Are you willing to take this puppy to Puppy Kindergarten and Obedience classes? And to otherwise make the effort required to properly socialize a young puppy?
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Are you willing to purchase and use a dog crate for training/housebreaking purposes?:yes or no and explain how many hours the puppy will have to be crated.
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| What type of personality do you like in dogs?: |
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| What traits do you dislike in dogs?: |
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| Do you prefer male, female, or have no preference?: |
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| Do you have specific color or marking preferences?: |
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| Are you committed to and prepared for taking care of this dog's needs for his/her entire life? yes or no: |
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| If you are not buying this puppy specifically as a show dog, are you willing to neuter/spay him/her? yes or no: |
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| If no, why not?: |
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| Please describe the stress level in your home, in a few words.: |
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| Please provide the name, address, and phone number of your veterinarian as a reference.: |
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| Applicant's Signature: |
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| Date: |
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| Your additional questions or comments: |
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