Name:
Address:
City:
State:
Zip:
Email Address:
Phone:
Fax:
URL:
Marital Status:
Married
Divored
Single
Widowed
Do you have children? If so, what are their ages?
What type of work do you do?
Who would be the primary care giver for your Cavalier King Charles Spaniel?
In what type hobbies do you currently participate?
Where did you hear about us?
Do you have a fenced in yard?
Yes
No
We plan to have one installed before we get our new puppy
Please tell us your plans for housing and exercising your Cavalier King Charles Spaniel.
Have you ever owned a Cavlier King Charles Spaniel?
Yes
No
If yes to the previous question, state details concerning your experience with them.
Do you currently own any Cavaliers?
Yes
No
If you answered yes to the previous question, how many do you have, and where are they from, please list them below along with age, sex and spay/neuter status.
Do you have any other pets? Ex: Horses, cats, other breeds of dogs, etc. If so please list.
If you currently do not own any dogs, can you tell me about your past exposure to dogs and dog ownership?
Have you ever had to return or remove a dog from your care because of problems with temperment or personal changes in your life?
Yes
No
If you answered yes to the previous question, please explain why.
What made you decide to purchase a Cavalier King Charles Spaniel?
Do you plan to participate in any of the following activities with your Cavalier King Charles Spaniel?
Agility Training
Breeding
Conformation Showing
Family Pet
Obedience Training
Tracking
Therapy Dog
Other
Are you aware of the health problems that are possible in this breed?
Yes
No
Have you read any books or articles about the breed?
Yes
No
Do you have a preference as to male or female?
Male
Female
I have no preference
Do you have a preference as to colour?
Black & Tan (black with tan markings)
Ruby (solid chestnut red)
Blenheim (chestnut red & white)
Tri colour (black & white with tan markings)
I have no preference
Are you a member of a dog breed club?
Yes
No
Not sure what this means
Please list a veterinary reference with telephone number.
Does anyone smoke in your house?
Yes
No
If you answered yes to the previous question, do you smoke inside the house or go outside to smoke?
stay inside to smoke
go outside all the time to smoke
go outside sometimes to smoke
smoking is not allowed inside this house
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