1) What is your name?

2) Are you already involved in Rescue? (not a requirement) Yes No If so, name of Rescue organization?

3) Please provide your address*. (Information with an asterisk * will not be shared beyond your state of location without your express permission.)

4) Contact Information: Telephone*

E-mail:

URL:

5) Occupation:

6) Your Age:

7) Are you married?: Yes No

8) Number of children, and their age(s):

9) Are you expecting a child, or planning a family in the future? Yes No

10) Do other children regularly visit your home? Yes No

11) Please list breed, age, and sex of all other dogs in the household:

12) Are these dogs spayed or neutered? If NOT, please explain why not...

13) How long have you owned each dog?

14) How many cats share the household, and what is their sex?

15) Are these cats spayed or neutered? If NOT, please explain why not...

16) Any other critters? Ferrets, hamsters, snakes, birds, etc?

17) Please provide the name, full address, phone (with area code), and e-mail (if applicable) of at least one veterinarian reference that is familiar with you, and your pets and provides the current vet care for your animals:

18a) Please describe the annual care (shots/worming/dental, etc.) given to your current animals and the method by which you prevent heartworms:

18) We live in a: House Apartment Condominium     Which we: Own Rent/Lease And our Landlord (if applicable):

DOES allow LARGE breed dogs Does NOT allow LARGE breed dogs Might allow a large breed dog; we are unsure

19) Our neighborhood/property is: Urban Suburban Rural

20) Do you have a yard/kennel area/paddock, and is the area SECURELY fenced?

Yes, we have a fenced yard/kennel area/paddock Yes, we have a yard but it is not fenced No, we do not have a yard

21) Please describe your fencing (location - house, kennel, or paddock) briefly (material used, when installed or age, *height):

22) Please tell us anything further about your family that you'd like to share:

23) Do you now, or have you ever owned a Great Pyrenees? Yes No

24) Please describe in detail any interaction you've had with the Pyrenees breed, including (but not limited to) other owners you have spoken to, books you have read, Pyrs you have met, etc; Also please give a general description of your knowledge of the breed:

25) If requested, would you be willing to attend obedience class with your foster?

Yes No

26) If someone referred you to Mississippi Great Pyrenees Rescue, please tell us so that we may thank them:

Either Male or Female - Doesn't Matter Female Male

28) Prefer what age?

29) Would you consider a mix?

Yes Maybe No

30) Are you able to handle and train dogs through a variety of difficulties?

31) What about the Great Pyrenees appeals to you?

32) Do you use a crate to contain a dog?

Yes No

33) If yes, under what conditions and, if no, where will the dog stay when alone?

34) Where will the dog sleep?

35) Please outline any other expectations or concerns you may have:

36) Would you like e-mail confirmation that your submission was received?

Yes please! No, thanks

37) Please provide two personal references whom we may contact. References should know you and your home well, and should be unrelated to you. Please provide names, addresses and phone numbers.

 Thank You So Much!!!!