Puppy Placement Application For Blossom Valley Ranch

APPLICATION TO ACQUIRE PARSON RUSSELL TERRIER

Email completed application to: BVRanch@cox.net and Annette.Gilliam@sce.com

Guardianship of another animal is a major responsibility and a long-term commitment. You may share 10-20 years of your life with the Parson Russell Terrier ("PRT") that you acquire. To get one of our special PRTs, you must be: (i) at least 18 years of age; and (ii) able and willing to spend the time and money necessary to provide the proper day-to-day care, training, and veterinary services for your PRT for its entire natural lifetime. If you wish to acquire one of our PRTs, please complete and return this application to us.

HOW DID YOU LEARN ABOUT BLOSSOM VALLEY PARSON RUSSELL TERRIERS?

AKC Breeder Litter Advertisement

Breeders.Net Listing

http://ParsonRussellTerriers.com website from online search

Newspaper Advertisement in

Personal referral from

AKC Conformation Dog Show contact with: ______________________________________

Other: _______________________________________________________________

PERSONAL INFORMATION:

Name: ___________________________________________________________________

Spouse/Partner: ___________________________________________________________

Address: ________________________________________________________________

City: ____________________________ State: _____________ Zip: ______________

Home phone: ______________ Work phone: _____________ Cell phone: _______________

How long have you lived at this address?_____________

May I visit your home to see the PRT and how you are taking care of it?____________

What is your occupation? ____________________________________________________

Name, address, phone number, and how long you have worked for your current employer:

_________________________________________________________________________

Home E-Mail: _________________________ Work E-Mail: __________________________

How many hours are you away from home each day? ________________

What is your spouse/partner’s occupation? __________________________________________

Name, address, phone number, and how long your spouse/partner has worked for his/her current employer:

_________________________________________________________________________

How many hours is your spouse/partner away from home each day? _______________

Home E-Mail: _________________________ Work E-Mail: ________________________

Your Age: ___ Age of Spouse/Partner: ___ No & ages. of Children: ___________________

Do any of the people in your home have allergies? No: ____________ Yes: ____________

Do you own or rent your home? __________ Is it a (check one): ___ house ___ apartment ___ condo?

Do you have a fenced yard? No: __ Yes: __ If 'yes," what size? ______________________

Do you have a pool? No: __ Yes: __ If "yes," is it fenced? ____ Height& material?_____________

EXPERIENCE WITH PRTS AND OTHER ANIMALS:

List the pets that you and your spouse/partner have had in your lives and state what happened to them:

___________________________________________________________________________

WHY DO YOU WANT TO HAVE A PRT?

___________________________________________________________________________

WHAT KIND OF PRT DO YOU WANT OR WILL YOU ACCEPT?

Sex desired: Male:__ Female:__ Either:__

Color desired: White:__ White/black markings:__ White/tan markings:__ Tri:__

Coat(s) acceptable: Smooth:__ Light broken:__ Heavy broken:__ Rough:__

Age(s) acceptable Puppy:__; 6-12 mos:__; 1 to 2 yrs old:__; adult:__

WHAT WILL YOU DO WITH YOUR PRT?

Activities: Conformation:___ Agility:___ Earthdog:___ Obedience:___ Rally:___

Will you take your PRT to basic training classes? No: ___ Yes: ___

If you do not show in conformation, are you willing to spay/neuter your PRT? No: ____ Yes: ____

Who will take primary care of and responsibility for the PRT?: ____________________________

Who will be responsible for the PRT if something happens to you? __________________________

__________________________________________________________________________

Where will your PRT stay during the day?____________________________________________

__________________________________________________________________________

Where will your PRT sleep at night? ________________________________________________

__________________________________________________________________________

If you go away for a few days, who will care for your PRT? _______________________________

__________________________________________________________________________

Under what circumstances would you give your PRT to a shelter, rescue organization, or back to me?

___________________________________________________________________________

If your puppy has an emergency or serious illness, what is the maximum you are willing or able to spend on veterinary care?

None __ $1-10 __ $11-50 __ $51-100 __ $101-500 __ $501-1,000 __ over $1,000 __

REFERENCES:

Name, address, and phone number of your veterinarian reference:___________________________

___________________________________________________________________________

Names, addresses, and phone numbers of three personal references who can vouch for your humane treatment of animals and will know your whereabouts in the future:

reference #1’s name:__________________________________________________________

address: ___________________________________________________________________

phone: ____________________________________________________________________

email address:_______________________________________________________________

reference #2’s name:__________________________________________________________

address: ___________________________________________________________________

phone: ____________________________________________________________________

email address:_______________________________________________________________

reference #3’s name:__________________________________________________________

address: ___________________________________________________________________

phone: ____________________________________________________________________

email address:_______________________________________________________________

AGREEMENT:

By typing or signing our name(s) below, I/we agree that:

•

My/our typed name(s) constitute(s) an electronic signature for legal purposes if transmitted electronically,

•

The facts provided in this application are true and correct to the best of my/our knowledge,

•

I/we realize that all such facts are material to the Breeder's decision to sell me/us a PRT,

•

Any such fact that is not true will constitute legal misrepresentation in the formation of any Contract of Sale ("Contract") that results from submission of this Application to Breeder,

•

Any material misrepresentation is grounds for the Breeder to immediately rescind any such Contract, and Breeder may repossess the dog that is the subject of the Contract and retain all money paid for the dog, as liquidated damages, since damages for such misrepresentation are difficult to determine, prove, and calculate.

Applicant's Signature: ________________________________________________________

Spouse/Partner's Signature: ____________________________________________________

Date: ______________ City/State where signed: ___________________________________

Additional Comments (if desired): _______________________________________________

________________________________________________________________________