Adoption Questionnaire Name*FirstLast Address* Street Address City State / Province / Region Postal / Zip Code Home Phone (enter mobile number if same)* Cell / Mobile (enter home number if same)* Email Address Preferred method of contact*Select valueCellHome PhoneEmailText Message Best time to reach by phoneHH : MM AMPMAM/PM Would you like to receive text messages for updates? YesNo What type of residence do you live in?*ApartmentCondo/TownhouseSingle Family Home Please confirm that your HOA/POA does not have restrictions on pets over 50 lbs.*I CONFIRM Do you rent or own your home?*RentOwn Does your landlord or rental agency allow pets?*YesNoThank you for considering Blue Ridge Akitas. Please contact us again when you are eligible to own a pet. Please note: Since you are renting, documentation will have to be provided by the landlord or leasing agency stating that you are permitted to have a pet of 50 lbs. or more. To avoid delays or forfeiture, please verify that you will be able to provide the required documentation prior to receiving your puppy.*Yes, I can provide the required documentationNo, I cannot provide the required documentationYou have indicated that you are permitted to have a pet yet cannot provide documentation stating so. If this is incorrect, please go back and correct the form.If this is correct and you need assistance getting verification, please contact Alicia at Blue Ridge Akitas. You will then be able to complete the adoption questionnaire.Thank you. Do you have a fenced-in area for your puppy?YesNoother Have you owned a dog before?*YesNo What Breed(s) Do you currently have other pets?*YesNo What other pet(s) do have? Have you ever given up a pet?YesNo Please explain the reason for giving up your pet Does anyone in the home have pet allergies?*YesNo Will your puppy be around children?*YesNo What ages?0-56-1213+ Where will your puppy be kept during the day?* Where will your puppy be kept during the evening / overnight?* How would you describe your (family's) activity level?*Couch potatoesMildy activeLike to be outdoorsVery activeWatch UFC to relax Add any other comments about your lifestyle, activities, hobbies or special needs you feel are important in choosing your puppy. Why do you want an Akita? I prefer aMaleFemaleIt doesn't matter How did you hear about Blue Ridge Akitas?Another puppy owner recommendationWeb searchLocal advertisementOtherSend a copy of this message to yourself Word VerificationSubmitReset Return Home