Name:

Occupation:

Children’s Names & Ages:

Address:

Phone#:

Alternate#:

Fax#:

eMail Address:

Veterinarian’s Name & Address:

Veterinarian Phone#:

Family Hobbies:

Puppy Gender Preference:

  Male
  Female
  No Preference

Do you plan to spay or neuter your dog?

  Yes
  No

Do you hope to breed your dog?

  Yes
  No

If yes, have you ever whelped a litter or owned a stud dog?

  Yes
  No

If yes, please relate your experiences:

If you plan to breed your dog, are you prepared to OFA (hips) and CERF (eye) clear your dog and to take your breeder’s advice on all aspects of the breeding?

  Yes
  No

What other animals live in your house?

Have you owned dogs before?

  Yes
  No

If yes, what kind(s) and how long?

Do you travel often?

  Yes
  No

If yes, where will your dog be when you travel?

Do you have the time and patience to groom a long-haired, double-coated dog?

  Yes
  No

Do you plan to use a professional groomer?

  Yes
  No

Do you move often?

  Yes
  No

Are you commited to living with this dog for the next 15 years or more?

  Yes
  No

What kind of area do you live in?

Do you plan to show your dog in.....

  Don’t plan to show
  Conformation
  Obedience
  Agility
  Herding

Will you attend obedience class with your puppy?

  Yes
  No

What attracted you to this breed?

Describe what you are looking for in a PON puppy; i.e. temperament, attitude, and personality: