Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Have you ever owned a Giant Breed dog before? *

Yes

No

Do you have other pets in your home? *

Yes

No

Do you currently live in a: *

House

Apartment

Condo

Duplex

Mobile Home

Other

Do you: *

Own

Rent

If renting, does your landlord allow pets?

Yes

No

I don't know

Are you ready for the 10-15 year commitment a Great Dane will require? *

Yes

No

Do you have children in your home? *

Yes

No

Do you have a fenced yard? *

Yes

No

Are you interested in a current or future litter? *

Current

Future

Does anyone in your home have allergies to animals? *

Yes

No

Do you agree to contact us for help/tips regarding any behavioral problems that may arise? *

Yes

No

Do you understand that you may need to utilize a behaviorist or trainer at some point during you puppy/dog's life? *

Yes

No

Do you understand that this dog/puppy should not be spayed or neutered until at least 12 months of age? *

Yes

No

Do you understand that if the puppy/dog does not work out, he/she may be returned to Southern Pines Family Danes and no recompense should be expected - unless the Health & Temperament Agreement applies. *

Yes

No

Do you understand that this form will act as a legal, binding document of agreement? *

Yes

No

Medical Release *

By submitting this form, I hereby authorize the Doctor of Veterinary Medicine, named above, to disclose and/or release to Southern Pines Family Danes, it's agents, successors or assigns, either verbally or in writing, complete information concerning his or her medical findings, treatments and records about any animals for which I have sought care and/or treatment from the so named Doctor of Veterinary Medicine. (***Please contact your vet to let them know we will be calling. They may require your permission before speaking with us. ***)

By checking here, I certify that the above information is true and correct

Liability Release and Waiver *

PLEASE NOTE: Your application cannot be processed without acceptance of this waiver. I/We have voluntarily contacted Southern Pines Family Danes and have expressed an interest in adopting a dog in the care and custody of Southern Pines Family Danes. In consideration of SPFD's agreement to allow me to view and/or interact with such dogs, I hereby, for myself, my heirs and my personal representatives, represent and warrant as follows: 1. I am fully aware of the risks that dogs pose and have elected to view and/or interact with one or more dogs in the care of SPFD voluntarily. I knowingly assume all risks that exposure to dogs may pose, including but not limited to, serious bodily injury and/or death. 2. I hereby waive, release, discharge, hold harmless, and promise to indemnify and not to bring suit against Southern Pines Family Danes, its directors, officers, volunteers, staff, and all other agents, and attorneys for any of the referenced parties, and any other parties acting for, or on behalf of any of the referenced parties, from any and all rights and claims which I have or which may hereafter accrue to me and from any and all damages which may be sustained by me directly or indirectly in connection with, or arising out of, my exposure to such dogs.

Yes, I accept this waiver and release Southern Pines Family Danes from all liability.