Name
*
First Name
Last Name
Phone (Home)
*
(###)
###
####
Phone (Work)
(###)
###
####
Email
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Referred by:
How many individuals of this breed are you acquainted with?
*
If renting, please give the name of the landlord:
First Name
Last Name
Landlord's Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Veterinarian's Name
*
First Name
Last Name
Veterinarian's Phone Number
*
(###)
###
####
Veterinarian's Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Who will be the primary care giver?
*
Where will the puppy be kept during the night?
*
Where will the puppy be kept during the day?
*
Is anyone at home during the day?
*
How many hours on the average will the puppy be left alone?
*
Will there be someone available to feed and exercise the puppy during the day?
*
Have you ever owned a dog before?
*
Do you have any other animals?
*
Do you have any children?
*
If yes, what are their ages?
Does anyone in your household have allergies?
*
If yes, to what and how severe?
Are you interested in a male or female puppy?
*
At what age do you wish to get the puppy?
*
Have you considered an older dog instead of a puppy?
*
How did you hear about this breed?
*
What do you expect the activity level of this breed to be?
*
What kind of floor surfaces will the dog be on in the house?
*
How many hours a day will the puppy be kept outside?
*
How will he be confined when he is outside?
*
Do you have a fenced yard or suitable pen?
*
Have you ever house trained a dog before?
*
How long have you lived at this address?
*
Will you be attending any training classes?
*
If yes, at what age will you start, which activities or competitions are you interested in, who is the trainer?
How long did your last pet live? What were the circumstances of its’ death?
*
Have you ever returned a pet to the breeder? If so, what were the circumstances?
*
Have you ever given a pet away? If so, what were the circumstances?
*
Have you ever taken a pet to a pound or shelter? If so, what were the circumstances?
*
Are you interested in showing the dog in the conformation ring?
*
Have you ever shown a dog to it’s championship?
*
Are you interested in competition in performance events such as obedience, agility, hunting, herding, etc?
*
Have you shown a dog to any performance titles?
*
Do you intend to breed the dog?
*
Do you understand the difference between limited registration and a full registration?
*
