| Name |
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| E-mail address |
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| Homepage URL |
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| Street address |
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| Phone (daytime) |
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| Evening Phone |
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| Is this your first papillon/phalene? |
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| When did you decide that a Papillon was for you and why? |
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| Have you read any books on the Papillon or researched any information |
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| Have you considered any other breed? If yes, what? |
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| List other pets or animals you have. (Species, breed, age, sex) |
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| Have you had pets in the past, which you no longer have? If yes, how did you lose them? |
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| Have you ever surrendered an animal to an animal shelter or rescue organization? |
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| List all household members. If children are included in your family, please list age and gender of each |
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| Are you aware of any allergies to animals of anyone in your household? |
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| Please tell us something about yourself, your family and your lifestyle. |
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| Do you rent or own your housing |
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| If rent, does your lease allow small dogs or does your landlord know |
Single family Duplex Apartment Other |
| Do you have a fenced yard where your puppy will be supervised, if not, what are your plans for exercising and for your puppy to go potty safely? |
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| How and where will your puppy spend his/her day? |
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| How and where will your puppy spend his/her nights? |
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| Would you be comfortable limiting or completely withholding vaccinations? |
Yes No Maybe, need more info |
| What type of personality are you looking for in a Papillon? For example a “go get ‘em” dog would not be happy in a home where only a low keyed lap dog is preferred and vice versa |
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| List all activities you might be interested in pursuing with your puppy. (Check all that apply) |
Household companion Therapy Obedience Flyball Agility Conformation shows Tracking Breeding Hiking 4-H Other |
| Do you prefer a puppy or an older dog? |
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| Do you have color or male/female pref.? |
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| Who will have primary responsibility for the care of the puppy? |
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| Are you or have you been a member of any dog clubs or organizations? |
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| anything else |
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| How did you find us? |
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