Name

Address

Phone number

Cell phone number

E mail address

Why a Welsh Terrier

Ever owned a terrier

What Breed of Terrier

Currently have any pets Yes No

What type age sex

Neutered or spayed

Tell about family household

Any children Yes No

Names ages gender

Family members Agree Oppose Accept idea of a Welsh Terrier

Where would puppy live Inside Yard Garage Other

Where would adult dog live Inside Yard Garage Other

Explain pet living arrangemt

Is yard fenced How

Your care training plan

Daily caregiver

Vacation arrangements

Do caregivers know agree Yes No

Vet name address phone

Want to compete with dog Yes No

What type competition Conformation Obedience Earthdog

Puppy gender interest Male Female Either

Willing to spay neuter Yes No

Willing to return for rehoming Yes No

What reasons for giving up

Work situation

Additional comments on family

Other comments or questions