Name:

Address:

City:

State:

Zip:

Home Phone:

Work Phone:

E-Mail:

Occupation:

1. Do you own or rent your home?

2. How long have you lived at this address?

3. How large is your yard/or how many acres?

4. Do you have a fenced yard?

5. If so, what type of fencing?

6. If you do not have fencing, how will you handle the puppies exercise and toilet duties?

7. How many adults and children in household?

8. Ages of children?

9. Do you own other dogs?

10. If yes, describe breed, sex, and age:

11. If you own other dog(s) are they neutered or spayed?

12. If you own cats are they declawed?

13. If you own a dog(s) and/or cat(s) please give the name, address, and phone number of your veterinarian:

14. Have you owned an Australian Shepherd before?

15. Why did you choose this breed?

16. What is your color preference?

17. Do you want a "Male" or Female"?

18. How many dogs have you owned in the last ten years?

19. If you have owned dogs in the last ten years that are not presently living with you, what happened to dog(s) and be specific:

20. Will the puppy reside in the house?

21. If you work how will the puppy spend its days?

22. How will the puppy spend the night? Crated or uncrated?

23. How many hours on the average will the dog spend alone per day?

24. List all plans for this dog: Pet, Guard, Herding, Obedience, Breeding, Conformation, Agility, Other:

25. Please provide any additional comments you would like to make:

All puppies not sold as Show/Breeding quality will go on Spay/Neuter contracts.