Matchmaking Intake Form Please fill out all required fields for form to properly submit. To check if form has submitted, click "Fill out intake form" button again. "*" indicates required fields Name* Preferred Pronouns Please list the other humans in the home and ages of children in the home.*Please list the other types of animals and their ages in the home.*Type of home*Apartment, Condo, House with/without fenced yard, etc. Address* Street Address 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 Phone*Email* Best time/day for our first session How did you hear about us?* Are you interested in a rescue dog or a purebred dog from a breeder?*Rescue dogPurebred dogOpen to eitherAre you looking for a male dog or a female dog?*MaleFemaleOpen to eitherWhat age dog would you prefer?*Baby Puppy (8-12 weeks)Puppy (3-6 months)Adolescent (6 months - 2 years)Adult (2-6 years)Senior (7+ years)Other (please specify)What size dog are you interested in finding?Small (up to 20 pounds)Medium (20-40 pounds)Large (40-60 pounds)Extra Large (60+ pounds)What coat type are you looking for?HairlessShort coatedDouble coatedLong hairLow sheddingWhat breeds of dogs are you interested in?What is your budget for acquiring a dog?Up to $500$500-1000$1000-3000More than $3000Are you willing to travel to acquire your new pet? If so, how far?Willing to travel up to 250 miles.Willing to travel up to 500 miles.Willing to travel up to 750 miles.Willing to travel any distance.I prefer to find locally.How long will your new pet be left alone each day?Never.2-4 hours4-6 hours6-8 hoursWhat activities are you interested in doing with your new dog?How much time are you willing to dedicate to training your new dog on a daily basis?None10 minutes30 minutes1 hourUnlimitedWhat type of energy level are you looking for?Couch potatoWeekend warriorActive companionAthlete / Working dogI understand that the package will expire four months from the purchase date. Please initial.* I understand that additional travel fees may apply depending on where I live. Please initial.* I understand that in the event of severe weather or other emergency the lesson may be postponed to the following week at the trainers discretion. Please initial.* I understand that children under the age of 12 must be accompanied by a non-participating adult. Please initial.* I understand that dogs must be up to date for their age on vaccinations in order to attend and will require proof of vaccinations. Please initial.* I accept all liability if any humans or dogs are harmed during training sessions. Please initial.* I understand that if I fail to give 24 hours notice to cancel my lesson, I will be charged a $50 no show fee. Please initial.* I agree to have my dog photographed or videoed and shared on the website or social media. I agree to have me and my dog photographed or videoed and shared on the website or social media. UntitledFirst ChoiceSecond ChoiceThird ChoiceUntitledFirst ChoiceSecond ChoiceThird Choice
