Name (first & last):*

E-mail Address:*

EMAIL NOTE: Due to some security protection issues, if you are using an @aol.com or @yahoo.com address, please use yourname@nativecanines.com in the email address section and note your correct email address in the comment section of this application.


City, State, ZIP:*


Home Phone:*

Work Phone:

How did you hear about us?

Why are you interested in getting a Vlcak puppy?

Tell us a little about your lifestyle and what you like to do.

Please take your time answering the following questions; answer all the questions.
Give us as much information as possible; if you need more room,
please use the comment section and label with the correct question number.

1. In what type of housing do you reside?

2. Do you live:

3. Do you

Unfortunately, if you do not own your home, we will not be able to place a Vlcak puppy with you. You may be asked to provide proof of homeownership, is that ok with you? yes no

If not, please explain

4. Do you have a fenced yard? yes no

They need a sanificant amount of both mental and physical exercise, are you able to take the time to exercise your Vlcak daily? yes no
Please explain how you will do this?

5. My household consists of the following number of:

adults (include their ages)

children (include their ages)

dogs (include age, sex & breed)

cats (include age, sex & breed)

other (include description)

6. I have owned dogs in the past (include number and length of time)

7. My dogs were:

other reasons:

8. Does anyone in the household have allergies? no yes, what type?

9. Do you expect to have children? yes no

10. Do you have a person living in the household that is

11. I am interested in a pet and plan to spay/neuter: yes no

12. I am interested in showing and/or breeding: yes no

13. I am interested in training my dog in:

Do you understand as part of our contract you will have to get some kind of title on your dog. You can choose CGC (Canine Good Citizen), Agility, Confirmation Dog Show, Herding , Tracking or other? This is a breed of Dog that needs a job to do. yes no

14. My dog will spend most of his/her time:

What do you plan on doing with your dog when you go on vacation?

15. The temperament I expect from my dog, as per the following possibilities would be:

The mailman knocks at the door with a package delivery, I want my dog to:

other, please explain

What would you do in this situation? Your neighbor and her son come over for a visit, the little boy starts crying and says your dog bit him. There is a puncture wound with a small amount of blood. You did not see it happen. Do you....

other, please explain

16. I would like a:

17. I would like a:

18. This is Very rare breed you will be an Ambassador. you will be expected to educate people and they will look to your dog as a reference for this breed so you and the dog must always be presented in a positive manner. Will this be OK by you yes no


19. Which family member will have the major responsibility for the dog?

20. How many hours a day would the dog be left alone?

21. If necessary, are you willing to crate train your Vlcak? yes no

22. Do you agree to return your Vlcak to us at Native Canines if you are unable to keep it? yes no

23. Are you willing to keep the dog up to date on all of its vaccines, screen for heartworm, use heartworm preventative and use flea preventative? yes no


24. Are you willing to pick up your puppy? yes no We do not ship via air. However, if necessary, we can arrange ground transport to you for an extra charge.

25. Are you willing to put up an outdoor kennel that is escape proof ? Thick Gage chain link or other steel fencing. NOT the thin Chain link kennels sold at Big Box stores. This is to include a fenced or wooden roof or tilt ins on a 6 ft or higher kennel. and a fenced or cemented floor. yes no


26. Are you willing to license your dog, keep it properly identified and abide by your state and local laws concerning dog ownership? yes no

27. Are you willing to provide us with the follow up reports and keep updated with current photographs a couple time a year or more? yes no


28. Who is your Veterinarian?


Address, City, State, ZIP:

Phone Number:

29. Please list 3 references (2 if you would like to count your Veterinarian). Please include complete names, addresses and telephone numbers:




By submitting this application, I (we) authorize the Veterinarian listed on this application to release information to Native Canines.

Applicant's name:


Additional Comments:
Reminder: Due to some security protection issues, if you are using an @aol.com or @yahoo.com address, please use yourname@nativecanines.com in the email address section and note your correct email address in the comment section of this application.

NOTE: If you are turned down for one of our puppies do not take it personal. We place puppies with people we know are a good match based on the two dogs temperaments we are breeding at the time.

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