Puppy Application

It is very important to us that we place each of our puppies in a home where the puppy will be a cherished member of the household. In order to do so, we know that it is important to match each puppy to the family's needs. Your response to this questionnaire helps us to know you and what you are looking for in your Kerry.

Please fill out as much of the questionnaire as possible.

Name(s):
Address:
City, State:
Zip:

Home Phone:		Work Phone:
Fax:		Email:

Household and Community:

Members of household, with children's ages and adults' occupations:
Name & Relation:	Adult Occupation:	Age:

Is someone home during the day? Yes No
If no, what is the longest time away?

You live in? House Townhouse Apartment/Condo

Own or Lease? Own Lease

Do you have a fenced yard?
Yes No

Where do you intend to keep your puppy/dog?
Indoor Outdoor

Does your city or county have a spay/neuter requirement for dog ownership?
Yes No

Routine, Care and Ownership:

Have you previously owned a Kerry Blue? Yes No
What other breeds of dogs have you owned?

What happened to your other dogs?

Do you currently have other pets? Yes No
If yes, specify type of pet, age and sex:

For what periods of time would the dog be left alone?

Are you able to spend more time with a puppy when it first goes home?

Do you currently have a "family" veterinarian? Yes No
If yes, please state name and telephone number:

Are you aware of the normal recurring expenses to own a pet Kerry Blue (medical, grooming, supplies, training, etc.)?
Yes No

Do you need more grooming information?
Yes No

How do you plan to manage the routine care and grooming of a Kerry Blue Terrier?

Who will be responsible for combing and brushing your Kerry every week?

Are you willing to attend puppy kindergarten class?
Yes No

Are you willing to crate train your puppy?
Yes No

Choices, Goals and Experience:

Do you have a preference as to male or female puppy?
Male Female

Why?

Why do you prefer a puppy over an adult dog?

Do you want a Kerry as a (check all that apply):
Companion/Pet
Show Prospect
Obedience Prospect
Agility Prospect
Protection Animal
Therapy Prospect

Please note: All PET pups are sold with an AKC limited registration. They cannot be shown in Confirmation, and if bred, their pups are not eligible for AKC registration. However, they can compete in Obedience, Agility, Rally, Fly ball, herding and hunting trials.

Any experience in showing, obedience training or breeding?

Ever attended a dog show or obedience trial?
Yes No

Are you willing to have your puppy spayed or neutered?
Yes No

If no, please explain:

Referrals:

Name	Phone Number

How were you referred to us?

Additional information you would like to give us:

I hereby certify that all the information contained on this application is true and correct. I understand that, If approved, I will be required to sign a Purchase contract. This application will become part of the agreement and any misrepresentation in this application will constitute a breach of the Conditions of Purchase.

Signature
Entering your name and today's date will be accepted as a signature.

Name:
Date: