Puppy Application - Disabled Name(Required) First Last Email(Required) Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneBest time to reach you: Morning Afternoon Evening FamilyMarriedSingleDivorcedOtherYour Age Children Do you live? City Rural House - own House - rent Apartment Other Do you have a secured fenced in area? Yes No Are you interested in: Puppy Older Trained Adult No Preference Gender Interested In: Female Male What qualities do you like in the Black Russian Terrier Breed?What don't you want to find in a Black Russian Terrier?Would this be your first Black Russian Terrier? Yes No Previously owned dogsAnimals living in your home currentlyPlease explain why you have chosen this time to bring a new dog into the family and how all the family members feel about itAre you committed to caring for this dog for its entire lifetime?Who will be the primary care giver for the puppy What percentage will your dog be in the following: House, Yard, OtherHave you house trained a puppy before? Yes No Have you trained a dog before? Yes No Are you willing to attend training classes with your puppy? Yes No Black Russian Terriers require regular grooming, who will be responsible for it Are you willing to spay/neuter this dog? Yes No If you are considering breeding do you promise to have all health testing done, finish it in the conformation ring, and title it in one of the working modalities as well as consult the breeder prior to breeding? Yes No Do you have any special concerns about the breed?When and where did you learn about the Black Russian Terrier breed? How did you hear about us? Would you like to come and meet our Black Russian Terriers? Yes No Maybe Are you willing to keep us informed of your puppy's progress with regular updates and photos Yes No Signature(Required)
