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): Do you prefer a Havanese or a Wheaten? Havanese Wheaten 1) Why do you want a Havanese/Wheaten? 2) Have you ever owned a Havanese/Wheaten 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 12) 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/Wheaten (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/Wheaten owner refer you to us (so we can thank them!) or how did you hear about us?
