Puppy Application – Legacy Chow Chows

First Name

Last Name

Country

Address Line 1

Address Line 2

City

State

ZIP Code

Phone

Name of your nearest airport

Have you ever owned aLegacy Chow Chows before?

Yes No

Do you have other pets in your home?

Yes No

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 chow chow puppy will require?

Yes No

Do you have children in your home?

Yes No

Where will your puppy be kept during the day & at night?

How many hours will your chow chow puppy spend alone without companionship?

Do you have a fenced yard?

Yes No

Have you ever used any of these payment options?

Western Union App (Pay With Debit Card) MoneyGram App (Pay With Debit Card)

Are you interested in a specific puppy/litter?

Gender Preference

Male Female Either

Please select your top 3 color preferences

(required)

What timeframe are you looking add a puppy to your family?

When your puppy is ready to join your family, will you need delivery or do you plan to pickup?

What temperament are you looking for in a puppy?

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 Legacy Chow Chow Puppy and no recompense should be expected - unless the Health & Temperament Agreement applies.

Yes No

Do you have any additional information about yourself and your family that will help us consider you for one of our puppies?

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

Yes No

How did you hear about us?

Do you have additional questions?

By submitting this form, I hereby authorize the Doctor of Veterinary Medicine, named above, to disclose and/or release to Legacy Chow Chows, 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

PLEASE NOTE: Your application cannot be processed without acceptance of this waiver. I/We have voluntarily contacted Legacy Chow Chows and have expressed an interest in adopting a dog in the care and custody of Legacy Chow Chows In consideration of Legacy Chow Chowss 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 Legacy Chow Chows 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 Legacy Chow Chows 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 Legacy Chow Chows from all liability.