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PUPPY APPLICATION

It is very important to us that we place each of our puppies in a home where the puppy will be a cherished member of the household. In order to do so, we know that it is important to match each puppy to the family's needs. Your response to this questionnaire helps us to know you and what you are looking for in your Kerry.
 Please fill out as much of the questionnaire as possible.

Name(s):  

Address:  

City, State:  

Zip:  

Home Phone:  

  Work Phone:  

Fax:  

  Email:  


Household and Community:


Members of household, with children's ages and adults' occupations:

Name & Relation:

Adult Occupation:

Age:

What are the family's favorite forms of recreation?

Is someone home during the day?
Yes   No

If no, what is the longest time away?

You live in? House   Townhouse   Apartment/Condo  

Own or Lease?

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Do you have a fenced yard?
Yes   No

Where do you intend to keep your puppy/dog?
Indoor   Outdoor

Do your neighbors have dogs?
Yes   No
If yes, what type or breed?

Does your community or homeowners' association have any restrictions regarding dogs?
Yes   No

Does your city or county have a spay/neuter requirement for dog ownership?
Yes   No


Routine, Care and Ownership:


Have you previously owned a Kerry Blue?
Yes   No

What other breeds of dog have you owned?

What happened to your other dogs?

Do you currently have other pets?
Yes   No

If yes, specify type of pet, age and sex:

How/where would the dog spend the day as a puppy?

How/where would the dog spend the day as an adult?

Where will the dog sleep?

For what periods of time would the dog be left alone?

Are you able to spend more time with a puppy when it first goes home?

Do you currently have a "family" veterinarian?
Yes   No

If yes, please state name and telephone number:

Are you aware of the normal recurring expenses to own a pet Kerry Blue (medical, grooming, supplies, training, etc.)?
Yes   No

Are you willing to provide these?
Yes   No

Are you aware of the Kerrie’s grooming needs?
Yes   No

Do you need more grooming information?
Yes   No

How do you plan to manage the routine care and grooming of a Kerry Blue Terrier?

Who will be responsible for combing and brushing on your Kerry every week?

Are you willing to attend puppy kindergarten class?
Yes   No

Do you plan on attending obedience training with your Kerry?
Yes   No

Are you willing to crate train your puppy?
Yes   No


Choices, Goals and Experience:


Do you have a preference as to male or female puppy?
Male   Female

Why?

Why do you prefer a puppy over an adult dog?

Do you want a Kerry as a (check all that apply):
Companion/Pet
Show Prospect
Obedience Prospect
Agility Prospect
Protection Animal
Therapy Prospect

Any experience in showing, obedience training or breeding?

Ever attended a dog show or obedience trial?
Yes   No

Are you willing to have your puppy spayed or neutered?
Yes   No

If no, please explain:


Referrals:

Name Phone Number



How did you become interested in a Kerry Blue Terrier?

How were you referred to us?

Additional information you would like to give us.

I hereby certify that all the information contained on this application is true and correct. I understand that, If approved, I will be required to sign a Purchase contract. This application will become part of the agreement and any misrepresentation in this application will constitute a breach of the Conditions of Purchase.
  Once submitted, you can also request references from us.
 Would you like to check our references?     Yes       No

Signature
Entering your name and today's date will be accepted as a signature.

Name:
Date: