Polka-Dot - Puppy Questionnaire

YOUR INFORMATION
Full Name*

First NameLast Name
Phone Number

Area CodePhone Number
E-mail*
City*
Province / State*
Number of persons living in your home?*
Number of Children (under 16) living in your home?*
Do you live in. . . ?*

apartmentcondosingle family homehobby farmhouse with property (2+ acres)farmOther
Is your yard fenced?*

YesNowe have no yard
WHAT ARE YOU LOOKING FOR:
Why are you considering a Chihuahua and not a Yorkshire Terrier or a Pug? (please be specific in regards to the traits found in the Chihuahau and not in other breeds)*
What is it about our dogs that interests you? (why do you want a dog from our breeding and not another breeder?) *
I am interested in:

A puppyAn older dogDoesn't matter
Male or Female?*

MaleFemaleDoesn't Matter
When are you looking to get a puppy?*
Coat Length*

I would like a Short CoatI would like a Long CoatI don't care
What colour of dog do you want?*

Black & WhiteMerleTri-colourI don't care

How important is colour*

	1	2	3	4	5

1 is Not important at all, 5 is VERY Important

Have you previously owned a Chihuahua?*

YesNo
Did you raise the dog from a puppy?*

YesNo
What types of activities would you like to pursue with your CHI?*

Pet/Companion OnlyCompetitive AgilityConformation (Dog shows)Competitive ObedienceDog Park Socializing (designated off leash parks for dogs to interact together)Therapy Work (Hospitals, Nursing homes)Emotional Support AnimalDock DivingFlyballOther
Do you currently own other pets? If Yes, please tell us about them.*
Do you have any interest in breeding your CHI?*

YesNoDon't know
Do you understand that we only sell our dogs on limited registration and you will not be able to breed your dog until it has passed required health testing?*

YesNo
How did you hear about Polka-Dot Chihuahuas?*

friendanother breederinternet searchFacebookmet a Polka-Dot dogOther
Do you have any questions?
Should be Empty: