First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Cell Phone*

Date (example 01/01/2019)*

Dog Preference 1 (If any, write any)*

Occasionally, a Malinois with special needs (physical restrictions or an unusual personality or preferences) is available for adoption. Would you be interested in being considered for a “special needs” dog? *

Name of any coordinator that you are working with.*

Applicant's Name*

Spouse's / Partner's Name

Number of Adults in Family*

Occupation 1*

Employer 1*

Occupation 2

Employer 2

Number of children in home.

Children's sex and age

Have you researched the Belgian Malinois?*

Why do you feel that the Malinois is the breed for you?*

Have you personally met any malinois and spent time with them? Please give details.*

What is your previous experience with dogs?*

What family activities would include the dog?*

Who is primarily responsible for the care of the dog?*

If approved to adopt would you take your Malinois to obedience training classes?*

How much time would the dog spend alone?*

How do you plan on caring for your dog if you are away from home more than 4 hours a day? *

Will you supervise while the dog is out in the yard?*

Which do you live in?*

Do you rent or own your home?*

If rent, what is your Landlords Name?

Landlord's Street Address

Landlord's City

Landlord's State

Landlord's Zip Code

Landlord's Phone

Please describe your landlords pet policy?

Is your residence fenced?*

If your answer was yes or partially describe your fence.

Will you modify your schedule to fulfill the dog's needs?*

Do you agree to limit kennel/crate time?*

Do you have local dog ordinances?*

If yes above, describe the dog ordinances.

Do you have a maximum dog limit in your town and are you at capacity?*

Are you part of a Home Owners Association? If yes do they have any restrictions related to pet ownership?*

What dogs have you owned in the past ten years? (List below with name, breed, sex, and age) *

What is the current status of dogs listed above? Currently with you, deceased, etc?*

What other pets do you currently own? (List below with name, breed, sex, and age)*

Do you understand that cats, small animals, and prey animals are at risk with a high prey drive dog?*

Have you ever bred dogs?*

Do you participate in dog shows or dog sports?*

Are you interested in participating in any of the following dog sports?

What is your training philosophy?*

What commands have you taught in the past?*

Are you familiar with crate training?*

If you are not familiar with using a crate, are you willing to learn?*

Would you walk and exercise the dog daily?*

Would you take your dog to your place of employment?*

What is your typical household energy level?*

Typically how many adults visit in a week?*

Typically how many children visit in a week?*

Would you supervise children around the dog at all times?*

Would your dog travel with you?*

Where would you travel with your dog?*

Which sex Malinois are you interested in?*

What additional information would you like to include?

Vet Name

Vet Street Address

Vet's City

Vet's State

Vet's Zip Code

Vet's Phone Number

First Personal Reference Name (No Relatives)*

First Personal Reference Email *

First Personal Reference Phone*

Second Personal Reference Name (No Relatives)*

Second Personal Reference Email *

Second Personal Reference Phone Number*

The adoptive family is required to meet transport halfway. Do you agree to this?*