Your name(s)______________________________________________________

Your street address ________________________________________________

Your city, state and zip code ________________________________________

Your email address _________________________________________________

Your home phone number ___________________________________________

Your cell phone number _____________________________________________

You are looking for a puppy/dog of what sex?  _____ no preference

          _____ female          _____ but would consider male

          _____ male             _____ but would consider female

Do you have a preference for a specific color?     _____ no preference

          _____ yes:  ______ black/white,  _____light sable,  _____ dark sable,

          _____ chocolate, _____ other: ________________________________

          _____ prefer: _____________________, but willing to consider others.

For what purpose are you interested in a Havanese? (check all that apply)

        _____ family pet, ______ obedience, _____ conformation shows,   

        _____ agility, _____ breeding program

Any puppy sold as a pet will be sold with AKC limited registration and a spay/neuter agreement.  Are you willing to agree to this?

          _____ yes,          _____ no

Have you spoken with any other Havanese breeders? _____ yes, _____ no

Are you aware of the few physical problems currently found in Havanese?

          _____ yes,          _____ no

Have you and your family ever met and played with a Havanese?

          _____ yes,          _____ no

Do you have children under the age of 5? _____ yes,           _____ no

Do you live in: _____ apartment, _____ house, _____ other: ______________

Do you rent or own your residence? _____ rent, _____ own

Do you have a fenced yard secure enough to hold a dog? _____ yes, ____ no

If not, how will you provide security for your puppy/dog when it is outside or

          when you are not at home? ___________________________________

Is there someone home during the day,or is anybody able to get home to

          potty a puppy/dog? _____ yes,           _____ no

Where will this puppy/dog spend the day?

          _____ outside, in the yard,

          _____ in the house, confined to a puppy-proof area,

          _____ in the house, loose

          _____ in the house, in its crate or kennel

          _____ other: _______________________________________________

Will the puppy/dog have regular contact with the family during the evening?

          _____ yes,          _____ no

Where will the puppy/dog sleep?

          _____ in its crate or kennel, in the bedroom

          _____ in its crate or kennel, in: ________________________________

          _____ in bed with me/us

          _____ in the garage

          _____ outside

          _____ other: _______________________________________________

Are you willing to attend group or private training classes with this

          puppy/dog? _____ yes,          _____ no

What breed(s) of dog do you have or have you owned?  If you haven't owned a dog before, please so state.  How many dogs and cats do you presently have?

If any of the dogs previously owned are deceased, what were the circumstances?

Who will have the primary responsibility for the care of this puppy/dog?

Please give the name, address and phone number of your vet (or one that has worked with you in the past).

Have you ever given a dog up to a shelter or pound?

          _____ no

          _____ yes, details: __________________________________________

What do you expect from a puppy/dog? For example, would you prefer a very active, outgoing dog or a quieter, more laid back pup?  Pleas take a little time to tell me what your ideal dog would be like.

We apologize for the length and detailed nature of this questionnaire, but we do our best to improve this breed and that includes finding the optimal family conditions for our puppies/dogs.  We believe strongly in prevention rather than repair.  The best way for us to make a successful placement for one of our pups is to match it, with its individual temperament, to a family whose personalities and lifestyle will suit it and appreciate its unique qualities.

Please feel free to add any comments and/or questions here.

Thank you for your patience.  We look forward to discussing this further with you after receiving your reply.