First Name/s:

    Last Name:

    D.O.B (dd/mm/yyyy):

    Street Address:

    Suburb, State Postcode:


    Second Phone:


    Personal Reference:

    Personal Reference 2:
    (If no vet reference)

    Most Recent Vet Used:

    Current Employment:

    Type of Employment:
    (full time, part time, casual)

    Employment Contact:

    Number of people living with you?

    How many children & ages?

    Is anyone in your household nervous around animals?

    How many hours per week will the dog be alone at home?

    Do you own or rent your house?

    If you rent do you have permission from the landlord?

    Landlords’s name and phone number?

    Do you have any other pets?

    If YES, how many and 
sex, age, breed

    Have you had a dog before?

    If YES, which breed/s?

    Do you have a backyard and is it safely fenced for a Chihuahua?

    Do you have a Pool/Pond?

    Does it have a chihuahua proof fence

    Where will the dog spend most of its time (inside or outside?)

    Where will the dog sleep?

    How will the dog get exercise?

    Do you have the use of a vehicle for vet or other appointments?

    Can you pick up the dog from his/her current location?

    Do you have a preference in sex or age of dog?

    Are you looking for a pure bred Chihuahua or mixed Chihuahua