Name:

Address:

Phone (home): work: Email:

Referred by (how did you find out about our dogs):

What reference materials have you read on the breed?

How many individuals of this breed are you acquainted with?

Type of dwelling: house townhouse apartment

Location of dwelling: city acreage farm

If renting, please give name and address of landlord:

Name, address and phone number of your veterinarian:

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 home during the day? Yes No

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? Yes No

Have you ever owned a dog before? Yes No What?
When?

Do you have any other animals now? Yes No What?

Do you have any children? Yes No If yes, what are their ages.

Does anyone in your household have allergies to animals? Yes No

If yes, to what and how severe?

Are you interested in a male or female puppy? Male Female

At what age do you wish to get the puppy?

Have you considered an older dog instead of a puppy? Yes No

How did you hear about this breed?

What do you expect the activity level of this breed to be: very high high moderate below average

How many hours per 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? Yes No

Have you ever house-trained a dog before? Yes No

How long have you lived at this address?

Will you be attending any training classes? Yes No

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? Yes No If so, what were the circumstances?

Have you ever given a pet away? Yes No If so, what were the circumstances?

Have you ever taken a pet to a pound or shelter? Yes No If so, what were the circumstances?

Are you interested in showing the dog in the conformation ring? Yes No

Have you ever shown a dog to its championship? Yes No

Are you interested in competition in performance events such as obedience, agility, hunting, etc.? Yes No

Have you shown a dog to any performance titles? Yes No

Do you hope to breed the dog? Yes No

Do you understand the difference between a non-breeding registration and a full registration? Yes No

Do you understand why the breeder may ask for a co-ownership on the puppy? Yes No

Please provide the names and contact information for two references that would know about any experience you may have with dogs (perhaps a trainer, groomer, veterinarian).

If this is your first dog, and the previous type of reference is not possible, are you willing to allow the breeder to visit your home (or have someone else do a home visit if you are at a distance) to help determine the suitability of one of our dogs in your situation? Yes No

Is there anything else you think we should know to make the best possible puppy selection for you?