Puppy Questionnaire

Name:
Phone:
Address:
City:
State:
Zip:
E-mail:
Occupation:
Business Phone:
Spouse or Second Owner’s Occupation:

Second Owner's Business Number:
Website (if any):

1. Why do you want a Havanese?
   
2. Have you ever owned a Havanese before?
   Yes
   No
   Do you still have that dog?
   Yes
   No
3. What happened to your last dog/s?
   
4. For what purpose do you want this dog?
   
5. Do you have any other animals?
   Yes
   No
   List type, age and sex:
   
6. Have you ever bred a litter?
   Yes
   No
   (If so, please explain breeds and number of litters.)
   
7. Please list names and ages of all people (adults and children) living in your household:
   
8. If you have children, what has been their experience with dogs?
   
9. Do you live in a:
   House
   Apartment
   Condo
   Trailer
   Do you rent or own?
   Rent
   Own
   
10. If you rent, do you have the landlord's permission to keep a dog?
    Yes
    No
    Name and number of landlord
    Name
    Number
11. Do you have a yard?
    Yes
    No
    What size yard (ex. ½ acre, 10 acres)?
    
    Is it fenced?
    Yes
    No
    What size and type of fencing?
    
    Is the fence enclosed to keep the dog from getting out?
    Yes
    No
    
Do all family adults work?
Yes
No
Is someone home during the day?
Yes
No

13. What provisions will be made for your Havanese if No one is at home during the day?
    
14. Do you intend to keep this dog primarily indoors or outdoors?
    Indoors
    Outdoors
15. Where will it sleep?
    
16. Do you have a sex preference?
    Male
    Female
    No Preference
17. Do you have a color preference?
    
18. Would you consider the opposite sex if it is a better match for your family?
    Yes
    No
19. Are you prepared to assume the financial responsibilities of caring for an animal, including inoculations, veterinarian care, good quality food, licensing, etc.?
    Yes
    No
    
20. Are you planning to move in the near future?
    Yes
    No
21. Is anyone in your house allergic to animals?
    Yes
    No
22. Are you familiar with the animal regulations in your area?
    Yes
    No
23. Do you understand that your puppy will need to be spayed/neutered between 6-10 months of age?
    Yes
    No
24. What circumstances, in your mind, justify getting rid of a dog?
    
25. Have you ever had to get rid of a dog?
    Yes
    No
    If Yes, why and what did you do?
    
26. Who will be responsible for the care of this dog?
    
27. What types of activities do you intend to do with your Havanese (conformation showing, agility, obedience, rally, therapy, flyball, etc.)?
    
28. Any other information that you would like to add about you and your family that may aid in matching the right dog with you (photos of your yard, home, family members, other pets, suggested but Not required)...
    
29. If you have one, please list VETERINARIAN’S:
    Name
    Address
    Phone
30. Did any current or previous havanese owner refer you to us (so we can thank them!) or how did you hear about us?