Name:
Address:
City, State & Zip:
Phone Number:
Email Address:
Number of Children: 0 1 2 3 4 5 6 ------
Sex & Age of Children:
Do you both work? Yes No ------
Occupations:
Do you own or rent? Own Rent ------
Private Residence or Apt? Private Apartment ------
Do you have a fenced yard? Yes No ------
Current Pets (breed & sex & age):
Previous pets, what happened to them?:
Veterinarian Name & Number:
Sex preference if any and why?
Personal References Names and phone or email of two

Check all that apply:

Are you interested in Breeding?
Showing?
Obedience?
Field?
Agility?
Are you willing to spay/neuter your puppy? yes no ------
How did you find out about WSS?
Are you willing to agree to attend Puppy Kindergarten & Obedience Classes? yes no ------
Are you willing to agree to return for rehoming any dog acquired from us if for any reason you decide not to keep him/her? yes no -----
Describe a typical day at your home:

What are your expectations?