Your Name (required)

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URL

Your Address

Your Phone Number (primary required)
Primary HomeWork Cell

Secondary CellHomeWork

Referred By

Type of dwelling
HouseCondoApartmentOther
If other

What reference material have you read on the breed or dogs in general?

How did you hear about the breed?

How many individuals of this breed are you acquainted with?

Do you have any children?
 Yes No
If yes, what ages

Do you have any other dogs and/or animals? If so what are they?

Are you interested in a male or female?
 Male Female Either

At what age do you wish to get the puppy?

Have you considered an older dog?
 Yes No

How many hours on average will the puppy be left alone during the day?

Where will he/she be kept when alone?

Do you have a fenced yard?
 Yes No
If no, are you willing to fence it?
 Yes No

Will you be attending any training classes for the Puppy?
 Yes No Would like or are willing to but need information

Are you interested in participating in competitions with your dog?
 Yes No

If so, what kind?
 Conformation Obedience Rally Agility Tracking Flyball Dock Diving Hunting Field Therapy

Have you received any titles on a dog?
 Yes No

If so which?
 Conformation Obedience Rally Agility Tracking Flyball Dock Diving Hunting Field Therapy

Do you intend to breed the dog?
 Yes No

Have you ever bred a dog?
 Yes No

If yes, were the Dam & Sire OFA\'d and CERF\'d?
 Yes No

(Required)
By clicking \"Yes\" below, I acknowledge that all information submitted in the above form is actuate to the best of my knowledge. I understand that any misrepresentation of facts could result in the removal of the dog from my home by Offshore Chesapeakes.  Yes