Do you live in a G House G Condo/Townhouse G Apartment G Mobile Home

Who will be the primary caregiver for your puppy?
Does the primary caregiver work outside the home? G Yes G No
m If yes, how many hours per day?
Will someone be available to feed and walk the puppy during the day? G Yes G No

Have you ever owned a dog before? G Yes G No
If Yes, what kind?
If you no longer own the dog(s) why not?

Do you own any other animals? G Yes G No
If Yes, what kind?

What draws you to Havanese?

Are you interested in a Havanese for: G Pet G Show G Agility G Breeding
Are you willing to sign a spay/neuter contract if purchasing a pet? G Yes G No
Have you ever shown a dog to a Championship? G Yes G No

Are you interested in a: G Male G Female G Either
Preferred age: G Puppy G Adult G Does not matter

Our family includes G Adults and G Children ages _______________

Have your children ever owned a pet? G Yes G No
What kind(s)?

How active is your household and how active do you expect your Havanese to be:
G Laid back G Moderately Active G Extremely Active

Does anyone in your house have allergies to animals? G Yes G No
If yes, have you consulted with your doctor about getting a Havanese? G Yes G No

Will you be attending any training classes with your Havanese? G Yes G No

Who is your veterinarian?

Name:

Address:

Phone:

Fax: