| Your Name: |
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| Address: |
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| City: |
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| State: |
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| Zip: |
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| Home Phone: |
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| Work Phone: |
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| E-mail: |
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| How large is your yard/or how many acres? |
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| Do you have a fenced yard? |
Yes
No |
| If so, what type of fencing? |
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If you do not have fencing, how will you handle
the puppies exercise and toilet duties? |
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| How many adults and children in household? |
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| Ages of children? |
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| Do you own other dogs? |
Yes
No |
| If yes, describe breed: |
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If you own a dog(s) and/or cat(s) please
give the name, address, and phone number
of your veterinarian: |
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| Why did you choose this breed? |
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| How many dogs have you owned in the last ten years? |
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If you have owned dogs in the last 10 years
that are not presently living with you, what happened
to the dog(s) and be specific: |
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| Will the puppy reside in the house? |
Yes
No |
| Will the puppy be allowed in main living space of house? |
Yes
No |
| If you work, how will the puppy spend its days? |
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| How will the puppy spend the night? Crated or Uncrated? |
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| How many hours on the average will the dog spend alone per day? |
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List all plans for this dog: Pet, Guard, Herding,
Obedience, Breeding, Conformation, Agility, Other: |
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| Additional Questions/Comments: |
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