Form
Puppy Request
* Obligatory fields
* Name
* Address
* City
* Prov/State
* Country and Postal Code
* E-mail
* Telephone
Telephone (others)
Owner or tenant?
Owner
Tenant
House or appartment/condo?
House
Appartment/Condo
Is there somebody at the house all the day?
Yes
No
Do you have a fence?
Yes
No
Do you take walks or another pedestrian activity?
Yes
No
How many children do you have?
Youngest is which age?
Have you or do you owned a dog(s)?
Yes
No
If so, which breed?
At which age was your dog deceased?
Which food did you give your dog?
Did you dog sleep outside or inside?
Outside
Inside
Other Comments:
Thank you for completing this form.
Marie-Élise Mathieu
Claude Chalut
MEM Cockers.