Application Form and Visitors Agreement

OFFICIAL APPLICATION FORM & VISITOR AGREEMENT REQUIRED FOR ALL WHO WISH TO VISIT MY HOME (VISITOR AGREEMENT BELOW APPLICATION)

Name *

Email *

Texting phone number *

Phone (you may write 'same' if applicable) *

Street Address *

Mailing Address (you may write 'Same' if applicable) *

Do you prefer contact on a social media platform? Which one, what is your contact name for that platform? I'm not on any, just a survey to see where I should be. *

What services are you interested in? *

Standard Adoption

Guardian Foster to Adopt (Locals)

Barter of Services equaling the cost of the dog

Service Dog

Preferred Date of Pick Up *

mm / dd / yyyy

How did you find us? Web search, Good Dog, Doggit, referral (If referral please list who referred you)? *

Do you prefer to be contacted via postal mail, email, text, social media, or phone call? I may have to use any or all at a given time but knowing which one you prefer is still helpful. *

Do you understand there is a contract to be signed? *

Are you committed to the time required daily, care, and expense of a dog? *

Is this dog going to be a companion dog (regular pet), facility dog (nursing home, etc.), Therapy dog (emotional support), Service dog (seizure alert, etc.)? *

What is your current or past veterinarian's name and phone number or website? *

Is this puppy to be a gift or surprise for another adult, are you sure they are prepared for the time and money involved in caring for a dog? The contract really needs to be signed by the person caring for the dog. *

Is anyone in the house allergic to dogs? If you are getting a shih tzu you are probably good for all but the severely allergic and even in that case weekly bathing helps, go easy on the soap as too much soap on everything and everybody is likely a contributor to itchy skin. If dalmatian, someone else should brush dog outside daily and wetting the dog to rinse off dander daily or weekly without soap every time to prevent skin conditions, we are just rinsing away loose hair and dander, a 99% water baby wipe will do in a pinch. *

Describe your ideal time to bring a puppy home? *

Describe your living situation, do you rent or own? If you rent, how does the landlord feel about your chosen breed? How long have you been at that residence? If under 5 years, how long at the last residence? *

Do all adults in the home agree to purchase a dog? *

Who will be primary caretaker of the dog and who will train the dog? *

Tell me about your outdoor space for a dog if you are not having an inside potty option? Fencing or commitment to a 20 foot lead and 3+ hours outside divided into 6+ outside visits daily in the beginning month to year depending on age and breed - shih tzu need more potty training time to catch on. *

Other people in home? ages of kids or grandparents, etc? *

Are you interested in having pick of the litter? *

What do you want to be on the waitlist for: boy, girl, shih tzu, dalmatian, puppy, adult? Just because they are older doesn't mean you don't have to show them potty training in your house as if they were a puppy for a week to a month minimum because the stress of the move and the new location is overwhelming and just because they learned it im my location doesn't translate to your location... learning to sit in the kitchen isn't the same as doing it outside - that is a 'new' trick in their mind. *

Do you have a size preference? Color preference? *

Is this your 1st dog? *

Is this your 1st puppy under 6 months of age? *

Other pets, exotic animals, or livestock in home or on property, please provide species, breed, age, sex (boy or girl), any medical or behavioral issues? This helps me address introduction and proper pairing so details please. Sometimes the older dog isn't interested in puppy antics, do a young friend play trial first as they might not be into playing with other dogs at all - find one at a dog training class or try out a daycare for a day as I cannot allow you to bring your dog to see if they like each other for disease prevention in young puppies that aren't as strong as adults as well as your dog might accidentally injure the puppy. Introductions should take weeks behind a closed baby gate so they can look and smell but not touch. Also, it is helpful to know what other breeds you have lived with and trained from puppy to adult before. If you are here for dalmatian, what large breeds have you trained? If you are here for shih tzu, what small breeds have you potty trained before? *

What is an ideal day with your new dog? Goals? Expectations? Do you have a fenced yard or smaller fenced area for potty time if you aren't okay with being outside a lot in the beginning because puppies need time to sniff and relax and potty a few times before you rush them inside (30 minutes each time in a covered area protected from rain and sun)- you can have your quick 5 min. or less potty breaks when they are older and you have trained them to potty on a leash on command? *

Describe where the puppy will spend most of it's time. Have you created your puppies safe space 'bedroom' with a pen and crate for their down time when they need a nap or to just get some quiet time? Zoomies are a sign that they need a nap. They don't need to be with you 24/7, it's not helpful for when you want to leave the house without anxiety. *

How many hours will the puppy be alone in 24 hours and at one time without a potty break? In the beginning they can't hold it for 8 hours, in fact if you held it that long for an extended period of time you'd eventually give yourself a bladder infection / UTI. For the dalmatian it is especially a problem because of the stone formation potential so lots of water and potty breaks are essential. Use a doggy door area, turf, pads, or pine pellet in a pan. If you are keeping shih tzu in coat to show raised floor grid is the preferred method. *

Are you willing to use an exercise pen, small baby gated area, or crate for training for the first few months minimum to ensure proper potty training and a safe introduction to other pets in the home? *

Do you live within 2 hours of Roanoke Virginia? Are you interested in being a guardian home with a rebate program per litter produced? A guardian home fosters a dog, living with, loving and training them while allowing them to help the program. *

Is there anything else you would like to tell me or ask?

Write your full legal name to sign this application. *

THE VISITOR AGREEMENT IS ONLY REQUIRED FOR THOSE WISHING TO VISIT THE HOUSE

EACH VISITOR IS REQUIRED TO FILL OUT THEIR OWN FORM FOR VISITING MY HOUSE UNLESS UNDER THE AGE OF 15

VISITORS AGREEMENT, LIABILITY WAIVER, ID SUBMISSION, AND CONSENT TO BACKGROUND CHECK FOR ALL VISITORS IN YOUR PARTY TO SIGN OFF ON

*you may need to refresh the page before you fill in below if you just submitted the application above*

BACKGROUND CHECK RELEASE & AUTHORIZATION This section is a legal release and requires a full signature — not initials. I, the undersigned Visitor, hereby authorize Mountain Pass Barn and/or its designated agents to conduct a background check as part of my application and visitor screening process. I understand that this authorization is voluntary but that refusal to provide authorization may result in denial of a visit or purchase opportunity. I release Mountain Pass Barn, its owners, employees, and agents from any liability arising from the use of information obtained through the background check process, provided such information is used in good faith. I certify that all information I have provided in my application and identification documents is true, accurate, and complete to the best of my knowledge. Full Printed Name, Full e-Signature and today's Date of Visitor in the box. Please also upload signature image below. *

BACKGROUND CHECK RELEASE Signature Image Upload - write your signature, take a picture and save it, then upload here: *

REQUIRED IDENTIFICATION IF YOU WANT TO COME TO THE HOUSE FOR ALL VISITORS WHO WILL FILL OUT THEIR OWN FORM. All visitors to Mountain Pass Barn must provide government-issued photo identification. The following ID requirements are mandatory and non-negotiable: ● A clear photograph or photocopy of the FRONT of a valid, government-issued photo ID (driver's license, state ID, or passport) must be submitted prior to the visit. ● A clear photograph or photocopy of the BACK of the same government-issued photo ID must also be submitted. Both front and back copies of ID must be uploaded through the document submission portal on the Mountain Pass Barn website at mountainpassbarn.com prior to the scheduled visit. Failure to submit required identification will result in cancellation of the visit. Please list all visitors in your party: *

FRONT and BACK ID Upload on one image together *

Extra upload space if unable to combine images -FRONT and BACK ID

*All visitors must submit their own form * This Visitor Agreement ("Agreement") is entered into between Mountain Pass Barn ("Breeder") and the prospective buyer/visitor ("Visitor") as a condition of scheduling a visit to our property and meeting our dogs. By signing this Agreement, the Visitor acknowledges and agrees to all terms outlined herein. -------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ***BIOSECURITY EXPANDED: You may not bring your pets on property. Everyone must agree to not touch or visit 48 hours prior to my home visit any other kennel, rescue, animal hospital, dog park, zoos, or any other location where sick dogs or other animals may be. You agree that you have not been around a dog or have a dog that has a cough, runny nose, parvo, or any other disease. You are not to wear clothing, shoes, jackets that have been near any of these facilities or animals in the past week. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ APPLICATION REQUIREMENT Before any visit may be scheduled or approved, the Visitor must complete and submit the full application available exclusively on the Mountain Pass Barn website at mountainpassbarn.com. No other application method or platform will be accepted. The Breeder does not accept applications through third-party platforms, marketplaces, or referral services for visitation of the private property. The visit will not be confirmed until the application has been reviewed and approved by the Breeder. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- REQUIRED IDENTIFICATION All visitors to Mountain Pass Barn must provide government-issued photo identification. The following ID requirements are mandatory and non-negotiable: ● A clear photograph or photocopy of the FRONT of a valid, government-issued photo ID (driver's license, state ID, or passport) must be submitted prior to the visit. ● A clear photograph or photocopy of the BACK of the same government-issued photo ID must also be submitted. Both front and back copies of ID must be uploaded through the document submission portal on the Mountain Pass Barn website at mountainpassbarn.com prior to the scheduled visit. Failure to submit required identification will result in cancellation of the visit. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------BACKGROUND CHECK CONSENT As a condition of visiting Mountain Pass Barn and being considered as a prospective buyer, the Visitor consents to a background check being conducted at the Breeder's discretion. The Visitor understands and agrees to the following: ● A background check may be initiated at any point during the application or visit process. ● The results of the background check may be used by the Breeder in determining whether to allow the person on the property or proceed with a sale. ● The Visitor's personal information provided through the application and identification documents will be used solely for verification and background check purposes. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------DOCUMENT SUBMISSION All required documents — including the application (submitted via mountainpassbarn.com), front and back copies of government-issued photo ID, and any other documents requested by the Breeder — must be submitted exclusively through the official document upload portal located on the Mountain Pass Barn website at mountainpassbarn.com. Documents submitted via email, text message, third-party apps, or any other method will not be accepted and will not be considered complete. It is the Visitor's responsibility to ensure all documents are fully uploaded and confirmed prior to scheduling the visit date. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- GENERAL VISITOR CONDUCT & ACKNOWLEDGMENTS The Visitor agrees to the following conditions during their visit to Mountain Pass Barn: ● The Visitor will adhere to all biosecurity and health protocols as directed by the Breeder upon arrival. ● Children must be supervised at all times by the accompanying adult. ● Visitors are not permitted to bring additional persons to the visit unless pre-approved by the Breeder in writing. ● The Visitor understands that a visit does not guarantee the right to purchase a puppy or dog. ● The Breeder reserves the right to refuse or terminate a visit at any time for any reason. ● All decisions regarding placement of puppies remain solely at the Breeder's discretion. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- LIABILITY WAIVER -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------1. Assumption of Risk: Participant understands and acknowledges that the Property is an active farm and dog breeding home with uneven ground – even on the driveway, natural terrain, animals, farm equipment, tools, and other potential hazards. Participant voluntarily assumes all risks of injury, harm, or damage that may occur while on the Property, including but not limited to slips, trips, falls, animal interactions, and contact with equipment or structures. --------------------------------------------------------------------------------------------------------2. Animal Interaction Clause : Participant understands and acknowledges that dogs and other animals on the Property may behave unpredictably. This may include jumping, scratching, nipping, tripping up, or knocking people over, as well as other normal animal behaviors. Participant voluntarily accepts all risks associated with interacting with or being near animals on the Property and agrees to follow all instructions provided by Owner regarding safe conduct around animals. ----------------------------------------------------------------------------3. Restricted Areas Clause: Participant understands that certain areas of the Property are restricted due to safety, privacy, or biosecurity concerns. You are allowed in the driveway parking area, any other location must be accompanied. No public bathrooms, there is a gas station in any direction within 5 minutes. You are here to see that I am a not a puppy mill not inspect my home and property. There is no seating area. You will not be allowed in the kennels, whelping areas, equipment zones, barns, storage areas, fenced sections, or any location you are not explicitly invited to and accompanied by me although you will be able to see it from the driveway as everything is really close. This is for biosecurity but also because everywhere is a tripping hazard because I live on a steep hill with ground hog holes, a driveway with potholes, and old houses have uneven flooring at every add-on. The winter is extension cord season and my house is small and to be in the kitchen gives direct view of the bedrooms. Participant accepts full responsibility for any injury, harm, or damage resulting from entering a restricted area, whether authorized or unauthorized. ---------------------------------------------------------------------------------------------------------------------------------------------------------------4. Release and Waiver of Liability: Participant releases, waives, and forever discharges Owner and Owner’s family members, employees, volunteers, agents, and representatives from any and all claims, demands, actions, or causes of action arising out of any injury, damage, or loss occurring on the Property, whether caused by negligence or otherwise. Participant agrees not to sue or bring any claim against Owner for any injury or damage sustained while on the Property. -----------------------------------------------------------------------------------------5. Indemnification: Participant agrees to indemnify and hold harmless Owner from any liability, damage, or costs (including attorney’s fees) arising from Participant’s presence on the Property or from Participant’s actions while on the Property. -------------------------------------------------------------------------------------------------------------------------------------------6. No Photo / No Video Policy: Participant agrees not to take, record, or capture any photos, videos, or audio while on the Property, including of animals, facilities, equipment, or individuals. Participant further agrees not to publish, post, share, or distribute any images or recordings of the Property or its animals taken at any time, whether previously captured or obtained by any means. Violation of this policy may result in immediate removal from the Property and potential legal action. -----------------------------------------------------------------------7. Personal Responsibility: Participant agrees to remain in designated areas, follow all instructions given by Owner, and exercise reasonable caution around animals, equipment, and uneven terrain. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------8. Medical Treatment: Participant authorizes Owner to seek emergency medical treatment if necessary and agrees to be responsible for any associated costs. ------------------------------9. Binding Effect: This Agreement is binding upon Participant, Participant’s heirs, executors, administrators, and assigns. Participant acknowledges that they have read, understand, and voluntarily agree to the terms of this Agreement. -------------------------------------------------------------------------------------------------------------------------------------Participant Printed Name:___ Signature: _____________ Date: ________ (Print name, sign, and date below in box as well as upload a picture of your signature in the second box below) *

VISITOR AGREEMENT AND LIABILITY WAIVER Signature Image Upload - write your signature, take a picture and save it, then upload here: *

We will meet in the front of my local police or fire station first. If all visitors are accounted for and there are no extra people or pets and background checks completed and I feel good about the meet you may follow me to the house to meet. If you would prefer not to do background check and you have already paid I can meet you at the firehouse or other location as agreed upon. If you prefer not to pay a deposit until you see the puppy and you don't want to allow a background check we will meet in front of the police station for the puppy sale and handover. Please Initial and date. *