Please note: we do require new families to sign an agreement and a preview of the agreement can be viewed by clicking
We need to know about you also, so please assist us with the following information.
A breeder who cares about her pup's future welfare, is a breeder who cares about her breeding decisions and the health & temperament of her dogs
Simply type your answers in the box beside every question, then press 'send'.
You need to answer every question for the form to 'send'
Please take the time to be informative for us
as this is our first step towards 'getting to know you'.
PLEASE NOTE THAT SOME FLEXIBILITY IN REGARD TO SEX AND/OR COLOUR WILL ASSIST US IN PROVIDING A PUPPY FOR YOU - PARTICULARLY IF YOU ARE SEEKING A BLENHEIM FEMALE.
1. Please advise your colour preference?
2. Please advise your preferred sex?
(it is as well to advise that with these popular puppies, flexibility of sex/colour is advisable)
3. Your full name:
4. Street no and name:
6a. PO Box, if applicable
7. Home Phone:
8. Mobile Phone:
Alternative Email (if required) :
10. Please provide details as to whether you and/or your partner are employed or not and if so the industry in which you work and position held?
The following three questions are seeking information for your future puppy's microchipping registration
- as with all information provided, please ensure you complete them correctly.
11. What is the name of your Local Council ?:
12. Please provide the name of an alternative contact, should you be uncontactable:
13. Alternative contact's phone numbers:
14. Are you a member of a Canine control Council: (yes/no)
15. if so Which Canine Council are you a member of? (name or n/a)
16. Please list the members of your family and their ages
17. Please advise name and age of primary carers of the puppy
18. Is puppy intended as a family pet (yes/no)?
19. Is puppy intended for agility/obedience (yes/no)?
20. Is puppy intended for showing or breeding (yes/no)?
21. Are you, or have you ever been, involved in breeding dogs of any breed or mixed breed, whether a registered breeder or not? If 'yes', please provide full details.
22. If puppy is intended for breeding or showing, please provide your Prefix name and/or membership number (please note that if this is not provided, then you may be unelligible for a show/breeding puppy until such time as evidence is received. Further details may be required for future breeding puppies)
23. Describe puppy's new home for us please including the security of fencing etc.
24. Please list any other pets you may have, including the breeds and whether they are desexed or entire.
25. Please advise whether puppy will live inside or outside the home, travel with you etc.,
26. Please describe your proposed exercise programme for puppy
27. Please provide details of your current veterinarian, including address and phone number
28. Would you be kind enough to describe puppy's future worming/innoculation programme for us please
29. Would you please give a short description of why you have chosen this breed
30. Please describe what you feel is your 'duty of care' for your new puppy
31. Would you like to go onto our waiting list if no suitable puppies are presently available? (yes/no)
32. How did you hear about us? (if website, please advise site name - what site did your Google search send you to )
33. Please confirm that you have read and accept our Terms and Conditions by typing 'yes' in the box
Before clicking on 'send' below, please ensure you have answered EVERY question otherwise the form won't send.
Our sincere thanks for taking the time to provide this information
IF YOU ARE HAVING DIFFICULTY IN SENDING THIS FORM,
PLEASE EMAIL US AT firstname.lastname@example.org TO LET US KNOW.