RIVERVIEW PUPPY QUESTIONNAIRECONTACT INFORMATIONName:* First Last Address: Street AddressCityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHome Phone:Cell Phone:Email:*How long have you lived at this address?:Referred by:BREED INFORMATIONHow did you hear about this breed?:What reference materials have you read?:How many individuals of this breed are you acquainted with? :What do you expect the activity level of this breed to be?Very HighHighModerateLowTYPE OF DWELLINGType of Dwelling:HouseCondoApartmentMobile HomeWhat kind of floor surfaces will the dog be on in the house?:If renting, please give contact information of landlord:Landlord Name: First Last Landlord Address: Street AddressCityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeLandlord Phone: Area Code - Phone Number FAMILY STATUSFamily Status:SingleMarriedSpouses Name:Does anyone in your household have allergies to animals?:YesNoIf yes, to what and how severe?If you have children living at home list names and ages:PUPPY PREFERENCESPuppy gender preference:MaleFemalePlease explain why?:Color Preference:BlenheimBlack & TanRubyTri-colorWhat are your plans for your Riverview cavalier?:Show DogObedienceAgilityTherapyHouse PetHave you ever shown a dog to it's championship?YesNoHave you ever shown a dog to any performance titles? YesNoDo you intend to breed the dog?YesNoPREVIOUS DOG EXPERIENCEHave you ever owned a dog before? YesNoHave you ever owned a cavalier before? YesNoList dogs currently owned including breed, registered name, and titles:List dogs previously owned including breed, registered name, and titles:How long did your last pet live? What where the circumstances of its' death?If you have any other animals please list them:Reason for wanting a Riverview cavalier:Are you currently a member of a dog show club, obedience club, or other dog club? List clubs in which you are a member:If you will be attending any training classes at what age will you start? Which activities/competitions are you interested in and who is the trainer?How far will you travel to get your puppy?What age do you wish to get your puppy? Have you considered an older dog instead of a puppy?YesNoIs someone home during the day?YesNoWho will be the primary care giver? How long will the puppy be left alone? How many hours a day will the puppy be kept outside? Where will the puppy be kept at night? Where will the puppy be during the day? Do you have a fenced yard?YesNoIf yes what is the approximate fenced size?Have you ever house trained a dog before?YesNoHave you ever returned a pet to the breeder? If so, what where the circumstances?Have you ever given a pet away? If so, what where the circumstances?Have you ever taken a pet to a pound or shelter? If so, what where the circumstances?Current or prior veterinarian for reference:Vet Name:Vet Address: Street AddressCityStateVet Phone: Area Code - Phone Number Do you understand the difference between limited and full registration? YesNoWhen you click submit, this form will be emailed to Riverview CavaliersWord Verification:SubmitReset
