Home to Alder Akitas

First Name :		Last Name :
Address :		City :
Prov/State :		Postal/Zip Code :
Phone :		Work Phone :
Spouse's Work Phone :

Date Submitted :
How did you here about Alder Akitas ?
Closest relative name and phone number :
If married or living together does other adult approve of getting this animal :
Children in household :	Ages :
Others in household who will have contact with dog :
Will the dog come in contact with children other than household children?	----- yes no
What dogs have you previously owned and for how long?
Dogs present at your home now ( Breed, Age, Sex ) :
Are they Spayed or Neutered? :
What other pets do you currently own :
Why are you interested in obtaining one of our Akitas?
Are you interested in a show potential or Companion ( All Pet puppies are sold on a CKC NON- Breeding contract and are strickly inforced ) :	----- Companion (pet) Show Dog Potential
Are you familiar with the characteristics and temperament of the Akita?
What qualities do you look for in an Akita?
Have you ever owned an Akita before?	----- yes no
Are you committed to caring for this dog for it's lifetime?	----- yes no
Do you have a fenced property/ and or kennel run?	----- yes no   PLEASE INCLUDE PICTURES OF YOUR PROPERTY AND FENCED YARD -- REQUIRED AND MUST ACCOMPANY APPLICATION.
Where will the dog stay during the Day/Night?
Have you ever raised a :	puppy    dog    both    neither
Who will have primary responsibility for caring for this dog?
Does this person fully understand the time and effort required to properly care for an Akita?	----- yes no
Will this person be willing to sign a moral obligation contract?	----- yes no
Have you ever obedience trained a dog?	----- yes no If "yes" where?
Would you be willing to obedience train a dog from Alder Akitas if it is required?	----- yes no
Would you be willing to allow someone from Alder Akitas or an agent from Alder Akitas to visit your home by appointment?	----- yes no
Please provide Three (3) references with telephone numbers :

Please tell us any other information you wish us to consider in placing one of our Akitas with you. We would appreciate it if you would give us a little insight into the expectations you may have for this new addition to your family. Alder Akitas will accept $100.00 non-refundable deposit for a companion and $200.00 non-refundable for a show potential. We must receive application and ALL other information before a deposit will be accepted.