Please print form and complete, contact me by e-mail to arrange delivery of form.

In order for us to help you select the “right” dog for your specific needs

PLEASE ANSWER THE FOLLOWING QUESTIONS THE BEST YOU CAN
Although these questions may seem personal they are important.

Circle all that apply, print clearly, Thank You.

1)      I would like a                            A) male                           B) female

2)      The temperament I expect from my dog, as per the following possibilities would be:

• The mailman knocks at the door with a package delivery, I want my dog to:

                                 A) bark, then make friends        B) bark, then chew him up

                                 C) bark, and not make friends   D) other: ______________________

• My dog and I are taking a walk in the park and I see some old friends.  I want my dog to:

               A) wag his tail                           B) attack them

               C) ignore them                          D) other: _____________________

3)      My dog will spend most of his time:

                  A) in the house                B) in a kennel run            C) running loose

                  D) in the fenced yard        E) on a chain                  F) other: __________

4)      I am interested in training my dog in:

                  A) obedience                   B) search & rescue/herding          C) Schutzhund

                  D) agility                         E) therapy/seeing eye                    F) other: __________

5)      I am interested in show and/or breeding:            YES                    NO

6)      I am interested in a pet & plan to spay/neuter.    YES                    NO        

7)      I have owned _____ dogs in the past _____ years.

8)      My dogs were:

                  A) given away        B) euthanized because ___________   C) other: __________

                  D) killed in accidents        E) died of old age

9)      My household consist of _______ dogs, (please list age, breed and sex):

         ___________________________________________________________________

         ___________________________________________________________________

10)    My household consists of:

         _____________ adults,           __________ children (ages) _____________________

         _____________ cats,              __________ birds (type) _______________________

         other: ______________________________________________________________

11)    Do you expect to have children?                                      YES                    NO

12)    The adults in my household are:   0-20        20-30     30-4     40-50     50-60       60 & up

13)    Please supply two references and contact numbers:    ___________________________

         ___________________________________________________________________

         ___________________________________________________________________

 
14)  Any comments you may have that may help us choose the correct temperament pup

       for you (ie. Lifestyle: runner, hiker, etc) would be appreciated

       ____________________________________________________________________

       ____________________________________________________________________

       ____________________________________________________________________

15)   My Veterinarian's name is _______________________________________________
       
        Name of Clinic _______________________________________________________

        Address of Clinic _____________________________________________________ 

                                        ___________________________________________________

        Clinic Phone # _______________________________________________________

If you have used more than one Veterinarian Clinic in the past 5 years, please provide their details as well on a separate piece of paper.

In the best interest of our puppies, please be advised that references from your veterinarian clinic will be called by us as a breeder, it is essential that our puppies our placed in homes where they will have the best of care possible.

Your veterinarian clinic should be able to verify that you have provided your pets with proper veterinarian care ( eg. Up-to-date vaccines) in the past.

Name: __________________________________________________________________

Address: ________________________________________________________________

City: __________________________ Province: _____________ Postal Code: __________

Home Phone: (___)-___-____  Work: (___)-___- ____  E-mail: ______________________