Your Name:      

Address:

Phone:               Email:    

Are you interested in a Dalmatian or Standard Manchester Terrier puppy, and please describe your primary reasons for selecting this breed?    

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

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

If interested in a Dalmatian puppy, please indicate color preference (if any):         Black Liver no preference

Do you currently, or have you owned this breed before?     Yes No

If yes, please describe:    

How old are they? Where did you buy them from? If deceased, what was the cause of death?    

Have you owned any other breeds of dogs before?     Yes No

If yes, please describe:    

Do you own cats or other pets?     Yes No

If yes, please describe:    

Do you have any children or do children frequently visit your home?     Yes No Plan to in the future

Tell us a bit about your family - (ages, hobbies, activities):    

Are all family members in agreement about the decision to acquire a puppy?     Yes No

Have you ever given away or sold a dog?     Yes No

Is your yard fenced? If yes, please describe the fence height and material.     Yes No

Does your yard have shade?     Yes No

What type of containment will you provide for your puppy (kennel, yard, run, fence, inside home, crate, etc)?                

How many hours will your puppy be left alone every day?                

Where will the dog stay when home alone?

Are you aware of the potential health problems associated with Dalmatians/Manchesters?                

What kind of food will you feed your Dalmatian? Are you aware of the problem of high "purine" foods causing urinary stones in Dalmatians?                

Please provide the name, address and phone number of your veterinarian.                

Please briefly tell us a little about yourself and your plans & goals for a new puppy.

Are you a member of any dog clubs? If yes, please describe?

Do you have any references that we can contact? (Please include name, contact information, and how they are associated with dogs.)

Will you take your puppy to obedience classes?     Yes No

Where will the puppy be when you are home (inside, outside, etc)?

Where will your puppy sleep?

What is the size of the yard where your puppy can play?

What exercise will you provide for your new puppy?

Does anyone in your household have allergies to dogs?     Yes No

Do you plan to crate train your new puppy?     Yes No

Any additional comments or questions for us?

Thank you for for your interest in a new puppy and for your time in completing the application. Please click on the submit button below, and we will be in touch with you soon.