Name 

Address 

Phone Number 

Email address 

Are you looking for a male or female puppy? Male Female

If your sex preference is not available or if there are not enough puppies in the litter are you willing to switch to the opposite sex? Yes No

Will your puppy be an inside or outside dog? Inside Outside

How will you provide for the exercise needs of your dog? 

How much time on a weekly basis will you spend with your dog? 

Are you planning to train you dog? Yes No

For what? Obedience Show Hunting Companion Therapy

Do you currently have other dogs? Yes No

If so, how long have you had your dog? 

As well, please describe your dogs.

Please describe your “Dream dog.”

Lastly, tell us anything else you would like us to know about your home, or what you are looking for in a puppy.