Please complete the following information and return to me



HAVACASA HAVANESE

Susan Murphy

havacasahavanese@

Please complete the following information and return to me. All information

provided will be kept confidential.

Your name:

Your street address:

Your city, state and zip:

Your e-mail address:

Phone number:

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 Havanese? (check all that apply)

__ family pet

__ obedience

__ conformation shows

__ agility

__ breeding

Any puppy sold as a pet will be sold with AKC limited registration and

spay/neuter agreement. Are you willing to agree to this?

__ yes

__ no

Have you spoken with any other Havanese breeders?

__ Yes

__ No

Are you aware of the few physical problems currently found in Havanese?

__ Yes

__ No

Have you and your family ever met and played with a Havanese?

__ Yes

__ No

Do you have children under the age of 5?

__ Yes

__ No

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 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 the puppy have regular contact with the family during the evening?

__ Yes

__ No

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?

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 to a shelter or pound? 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. 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 this further with

you after receiving your reply. My puppies are raised in the house and are

thoroughly socialized.

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