Name: 

Contact Tele #

State you live in:

Occupation:

Email Address:

How you found us:Please list site ie: Google search

Please tell us a little about the make up of your household: Spouse Single Life Partner Roommate

Do you have any children? None 0-1year 2-6 years 7-12years 13-18years Please choose as many as apply by holding down the Control Key for multiple selections

Is everyone in your household committed to raising a puppy or adult dog ? Yes No

Is anyone in your home allergic to pet dander? YES NO

How many hours each day during the "work week" will your dog be left alone? 1-2hrs 3-4hours 5-6hours 7-8hours 9-10hrs More than 10 hours

Do you have a secure place to leave your pet while you are away from home? Where will your pet sleep at night? *NOTE: My breeds do not do well confined alone in a pen or yard for long periods!*

Please tell us a little about your family:

What type of home do you have? Home with fenced yard Apartment Condo with fenced yard House with NO fenced yard Condo with NO fenced yard Other

Do you have a fenced yard YES  NO if no, are you willing to exercise your dog daily, pay a dog sitter/walker or put up a secure fence around your property?

Do you rent or own your home? Own Rent If you rent are you permitted to have a dog? Yes No

Who will be responsible for the care of your new pet? You (adult) The Children

How would you describe your family? Active Outdoor Type Quiet indoor type

What family activities would you include your pet in:

If travel plans took you away from home, what arrangements would you make for your dog? Friend Family In Home Pet Sitter Dog Hotel Boarding Kennel Take With You

Training and proper socialization are important to a puppy's development into a secure and happy companion. Can you devote the time needed during the critical first few months to teach manners and expose your puppy to many new experiences? Do you have any ideas about where you would go for obedience training or socialization? Yes No

The breeds that I offer, need monthly grooming and daily coat care. Are you prepared financially and time wise to maintain your dogs grooming needs for it's entire life? Yes No
 

Do you have a veterinarian that you use, or have used in the past? Yes No My breeds typically live up to 15yrs old. Are you prepared financially to maintain their good health for their entire life with vet visits, shots, medications etc?

In what rooms of your home will your dog be permitted? Do you have any ideas about how you will keep your dog out of certain parts of your home, if necessary?

Have you thought about housebreaking a puppy and handling an adult dog? What about potty needs? Where will your dog go to eliminate? How will you clean up?

Breed of interest: Mini Cocker Spaniel Standard Cocker Spaniel Japanese ShiShi Spaniel

Sex of puppy: Male Female Any

Color of puppy: Buff Chocolate Sable Black and Tan Black Parti Color Merle Tri Color

Are you set on the sex of the puppy? Yes No

Are you set on the color of the puppy? Yes No

Have you ever owned a dog before? Yes No

Have you ever had to return your pet to the breeder, surrender your pet to a rescue or humane society, sell your pet or give it away? YES NO If you answered yes please explain:

Have you read any books or done any research on the

breed you are requesting? Yes No

Do you currently have any other animals in your home? Yes No

If YES, please tell me about them: are they spayed/neutered?

What are your expectations for your new puppy?

Please choose as many as apply by holding down the Control Key for multiple selections:

Companion Obedience Agility Tracking Rescue Therapy Work

Tell me why you are interested in having a puppy :Thank you for taking the time to answer these important questions. Purchasing a puppy is a commitment for the lifetime of the dog. Your happiness and the health, safety and well-being of your new puppy should not be left to chance.

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