Wufoo

Personal Information

Your information is for the private use of Deebet Registered in assessing suitable match ups of families with companion puppies. Fields marked with aterisks (*) are required.
Name * Title First Last Suffix
Please enter your name in full.
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number * ### - ### - ####
E-mail Address

Please fill in your e-mail address, for example:
yourname@yoursite.com
Web Site (if you have one)

If you have a Web site that you would like to share please type the www.yoursite.com address in this space.
What activity best describes why you want a puppy?
Companion Conformation Shows Competitive Obedience/Sports
Living Arrangements

This section provides information on the number of people in the family and housing situations that will affect the living conditions of your puppy.
How Many Adults Live in Your Home? *
How Many Children Live in Your Home? *
Does Anyone in the Household Suffer from Allergies? *
No one in the house is allergic to dogs. Yes (if yes, please fill in details below).
Details of Allergies:
If a family member suffers from allergies please provide details particularly if the allergies are dog specific.
Does Everyone in Your Household Want a Dog? *
Yes No (if you answered no please provide details below.)
Details for above field.
If you answered no to the above question, please provide details and how you will handle this situation.
Will this be your family's first puppy? *
Yes No (if no, see field below)
If NOT your first dog, what experience do you have with raising dogs?
Do you own other pets? If yes, please describe them. *
Do You Have a Fenced Yard? *
Yes No
Do you have a swimming pool? If so, what arrangements will you provide for the safety of the puppy?
Care and Training

This section provides information on arrangements for the care and training of your new puppy.
Are you and your family committed to care for this puppy for its lifetime, which could be up to 16 years? *
Yes No
Have you ever had a pet that you needed to find a new home for or take to a shelter? Yes or no. If yes, please explain the situation and what happened below.
Do you work outside the home? If so, will the puppy be alone all day and what arrangements will you provide for the puppy's care? *
Have you attended obedience class with any other dog? If so, where and when?
Have you considered the cost of properly caring for and raising a puppy and if the expense comfortably fits into your budget? *
Yes No
What is the name and phone of the veterinarian you plan on using for your new puppy?
Do you have any questions on the care, training or ownership of a Toy Manchester Terrier?
Do Not Fill This Out

Wufoo

Personal Information

Living Arrangements

Care and Training