Puppy Application *Required Name:* E-Mail Address:* Address: City: State: Choose Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Postal Code: Phone Number:* Alternate Phone: Questions for you Are you familiar with the Portuguese Water Dog breed? Choose No I am not familiar with the PWD breed. Yes I am familiar with the PWD breed. Why do you think a PWD is the breed of dog for you? Have you ever owned a PWD before? Choose Yes I have owned a PWD before. No I have not owned a PWD before. Are you looking for a Choose Young Puppy Older Dog Do you have a dog now in your home? Choose Yes No If so is your dog a Choose N/A Male female What sex are you looking for ? Choose No Preference Male Female What type of coat do you prefer? Choose No Preference Wavy Curly What is the most important thing you are looking for in a puppy? What are the main reasons for purchasing a PWD puppy: Choose Family Companion Show prospect Breeding Obedience competition Pet therapy Tracking Are all member of the family ready for a new dog? Choose Yes No Will you be making any major changes in your lifestyle in next year? Choose No Moving Marriage New Baby Does anyone in your home have allergies? Choose No Yes Do you live in a: Choose House Townhouse Condominium Apartment Do you own or rent where you presently reside? Choose Own Rent If you rent have you discussed having a dog with your current landlord? Choose N/A Yes No Please provide your landlords name and phone number. Do you have a yard completely fenced with secure fencing? Choose No Yes Do you currently own any other pets? Choose No Yes Do you have children in the home? Choose No Yes Would someone be home with the dog during the day? Choose No Yes If no one is going to be home during the day please explain who will be caring for the puppy? Are you willing to crate train your new puppy? Choose No Yes Are you willing to take your puppy to puppy socialization classes and then on to obedience classes? Choose No Yes If this puppy is purchased as a family companion and not going to be bred, do you agree to have it spayed or neutered and submit a veterinarian certificate to the breeder. Choose No Yes Are you willing to contact us and keep us informed of any problems that may develop with the puppy throughout its' entire lifetime? Choose No Yes Are you willing to take send us updates and photos periodically? Choose No Yes Are you willing to allow the breeder or a friend of the breeder into your home for a visit to see how the puppy has adjusted to its new home? Choose No Yes Have you ever had to euthanize a puppy or dog other than for old age? If so, please explain:

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