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First name
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Last name
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Phone
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Which Puppy are you interested in? (Type "Waiting List" if there's no available puppies)
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Do you have any pets in your home?
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Yes
No
If "yes" to last question, please list your pets below. Include species, breed, and gender (N/A if not applicable)
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How many people live in your home including children
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Have you ever owned a Brussels Griffon?
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Yes
No
If "yes" to last question, please explain your experience with the breed. (How many you've adopted, whether or not you still have them in your care, how old they are or lived to be.) (N/A if not applicable)
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Do you understand the restrictions and requirements of a Brachycephaly dog? (Short snout, flat-faced, deep chested) Please Explain or put "No" if you are unaware of the requirements.
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Do you understand that getting a puppy is a commitment to the puppy that you will care for it for all of his/her life?
Yes
No
Is there anything else you'd like to share?
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