By The Bay’s Questionnaire for prospective
Please complete the
following information and return to me either via email attachment or regular mail.
All information provided will be kept confidential.
Today’s date:
Your name:
Your street address:
Your city, state and zip:
Your e-mail address:
Phone number:
Occupation:
Hobbies:
You are looking for a puppy
of what sex?
__ female
__ male
__ female, would consider male
__ male, would consider female
__ no preference
Are you looking for a
specific color?
__ yes (if so, what color? _______________)
__ no
__ prefer _________________ (but willing to consider
others.)
For what purpose are you
interested in a
__ family pet
__ obedience
__ conformation shows
__ agility
__ breeding
When would you like to add a puppy to your home?____________
Any puppy sold as a pet may be sold with AKC
limited registration and/or spay/neuter agreement. Do you have a problem with
this?
__ yes
__ no
Have you spoken with any other Havanese/
__
Yes
__
No
Are you aware of the physical problems currently
found in Havanese?
__
Yes
__
No
Have you and your family ever met and played
with the breed?
__
Yes
__
No
Who else resides in your home, please list ages
of children?_______________________________
Do you live in:
__
apartment
__
house
__
townhouse
__
other (please specify _________________________________)
Do you rent or own your residence?
__ Rent
__
Own
Do you have a fenced yard secure enough to hold
a small dog?
__
Yes
__
No
If not, how will you provide security for your puppy 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?
__
Yes
__
No
Where will this puppy spend the day?
__
Outside, in the yard
__ In the house, confined to a puppy-proof area
__
In the house, loose
__
In its crate
__
Other (Please specify ______________________________________)
Will this pup have regular contact with the
family during the evening?
__
Yes
__
No
How many hours a day will the puppy be left alone? _______
Where will the puppy sleep?
__
In its crate, in the bedroom
__ In its crate, in (fill in room) _________________
__
In bed with us
__
In the garage
__
Outside
__
Other (Please specify) ____________________________________
Are you willing to attend group-training classes
with this 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, and what are their ages?
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?
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? If so, why?
What kind of diet (brand name) do you think you
will feed your puppy?
What do you expect from a puppy?
For example, would you prefer a very active, outgoing dog or a quieter,
more laid back pup? Please take a little
time to tell me what your ideal dog would be like:
I apologize for the length and detailed nature
of this questionnaire, but I do my best to improve this breed and that includes
finding the optimal family conditions for my puppies. As a concerned breeder I believe strongly in
prevention rather than repair. The best
way for me to make a successful placement for one of my 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. I look forward to discussing Havanese further with you after receiving your reply.
Please visit the HEART website (www.havaneseheart.org) for educational
information on health issues.
For more Havana Silk Dog
information including its history visit www.havanasilkdog.org
For information on the AKC parent breed club visit www.havanese.org
To purchase The Havanese, by Diane Klumb
please visit www.lulu.com 
Ann Carille
By The Bay Havanese
(757) 496-7987
www.HavanaSilkDogsByTheBay.com
