1. Your Name:      
   

   Address:
   

   Phone:               Email:    

2. Explain why you want to add a Dalmatian to your family:    

3. Please select gender of puppy you are interested in:           Male Female no preference

4. Please select type of puppy you are interested in:           Pet Show Obedience Performance All of the Above

5. Color preference (if any):         Black Liver no preference

6. Will you spay/neuter the puppy?     Yes No

   If no, why not?    

7. Do you currently, or have you previously owned Dalmatians?     Yes No

   If no, skip to question 8. If yes, please describe:    

   Please tell us about your current or previous Dalmatians. How old are they? Where did you buy them? If deceased, what was the cause of death?    

8. Have you previously owned any other breeds of dogs?     Yes No

   If yes, please describe:    

9. Have you ever owned a puppy before?     Yes No

   If yes, how old was it when it came to live with you?    

10. Do you have any children?     Yes No

11. Please tell us about your family - spouse, significant other, children (ages, hobbies, activities):    

12. Are all family members in agreement about your decision to acquire a puppy?     Yes No

13. Who will be the primary caretaker of this dog? Please include name, age, and occupation.    

14. Have you ever surrendered a dog to an animal shelter?     Yes No

15. Have you ever euthanized a dog before?     Yes No

    If yes, why?    

16. Do you live in a single family home, an apartment or a townhouse?     Single Family Home Apartment Condo/Townhome

17. Do you live in city, the suburbs or the country?     City Suburbs Country/Townhome

18. Will your puppy live in the house with you or outside?     Inside Outside

19. Is your yard fenced?     Yes No

20. What type of containment will you provide for your Dalmatian (kennel, yard, run, fence, inside home, crate, etc)? Please include all that will apply.
                   

21. Where will your Dalmatian sleep?
                   

22. Will you crate train your new Dalmatian?
    

23. How will you exercise your Dalmatian?
    

24. Where do you work? Where will the puppy be kept while you are at work? How long will the puppy be alone during the work day? Will the puppy have access to the outside or be kept outside during the day?
                   

25. Will you take your puppy to basic obedience classes?     Yes No

26. Are you aware of the potential health problems associated with Dalmatians? Please briefly describe your understanding of these problems.
                   

27. Who is your veterinarian? Do I have permission to contact him or her? How frequently do your dogs see the veterinarian?
                   

28. Please list references that I can contact. (Preferably people who own purebred dogs) Please include names, phone numbers and/or e-mail.
    

29. How did you learn about jUjU Dalmatians?
    

30. Any additional comments or questions for us?
    

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