Date:                                                                     

Dog You are interested in adopting:                 

Full Name Of Applicant:                                     

Address 1:                                                           

Address 2:                                                           

City State, Zip :                                                    

Home Phone:                                                       

Email Address:                                                    

Why do you want an Akita?:                               

Have you ever owned an Akita before?              yes no

Did You Know...

Akitas can be dog aggressive, and generally

do not get along with dogs of the same sex?      yes no

Akitas should NEVER be chained, tied or

tethered?                                                               yes no

Akitas may NEVER be allowed to roam free?    yes no

Akitas shed HEAVILY twice a year?                   yes no

Akitas are a naturally dominant breed that require

obedience training WITH their owner?               yes no

Akitas live between 10-15 years and require a commitment

for that long?                                                           yes no

Do you still feel the Akita is the breed for you?        yes no

How Long at current address?                               own rent

If you rent, does your lease permit large dogs?       yes no

**We will require your landlords phone number**

Is the yard fenced?      yes no             Height of fencing?

Approximate size of yard                                         

What is the number of people in the home?           

What are the ages of any children in the home?    

Please list any other pets in the home along with   

sex, and type.                                                    

Name of current veterinarian and phone number.