Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Email Address
*
Puppy Use
*
Sex
*
Male
Female
Color
*
Black and Tan
Black and Red
Bicolor
Sable
Long Hair
Names and ages of children
*
Have you previously owned a dog?
*
Have you previously owned this breed?
*
If yes, please provide the following for each dog you have owned Breed (or predominate breed if mixed)
How obtained (purchased, found, gift, adopted, etc.)
Age when obtained
What happened to the dog: (sold, given away, lost, died--include cause of death)
What animals do you currently own?
Do you breed dogs now, or have you had experience breeding dogs?
Which of the following best fits the primary reason(s) you would like to have a dog?
If you marked more than one above, please list them by priority below
What specifically attracted you to this breed? how did you become interested in owning one?
Your Occupation
Work Schedule
Typical hours per week
How many hours per day would be the dog be left alone?
Who will be the primary caretaker of the dog?
Do you own your home?
Yes
No
If renting , do you have landlord's permission to have a dog?
Yes
No
Where would the dog spend most of its time?
Where would the dog's sleeping quarters be?
Check those that apply to the dog's outdoor space
If fenced yard, what type is it?
How will your dog be transported?
What family activities will include your dog?
What type of temperament would you like the puppy to have?
Explain why you selected your choice above
