| First Name: |
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| Last Name: |
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| Address Street 1: |
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| Address Street 2: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Daytime Phone: |
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| Evening Phone: |
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| Email: |
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| How many people are in your family? |
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| What are there ages? |
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| How active is your lifestyle? |
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Does anyone in your family have any allergies?
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| Do you plan on adding a baby to your household in the near future? |
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| Is everyone in your family equally as positive about getting a new puppy? |
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| Who will be the primary care giver for your puppy? |
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| Will that person be home during the day? |
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| Who will take care of the puppy in their absence? |
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| Do you live in an home, condo or apartment? |
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| Do you have a fenced yard? |
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| If not, how do you plan on exercisng your dog? |
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| Will your puppy be an indoor or outdoor dog? |
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| Have your ever owned a dog before? |
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| If so what kind and what happened to them? |
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| Have you ever and/or do you plan on using a crate for your dog? |
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| Have you ever trained a dog in obedience? |
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| What attracted you to an English Springer Spaniel? |
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| Have you researched the health issues and diseases that can affect English Springer Spaniels? |
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| Have you ever owned an English Springer Spaniel before? |
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| Do you understand that English Springer Spaniels shed and require regular grooming? |
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| Do you have an interest in showing your Springer in conformation, obedience or agility? |
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| Do you have a preference in the color or sex of your puppy? |
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