Costerra Kerry Blue Terrier - Dog/Puppy Application

Let's collect some information!

We would like to stay in touch! Please fill out the application to the best of your ability.

Date* This field is required.

Date

Name* This field is required.

First Name

Last Name

How did you hear about us?* This field is required.

Facebook Page

USKBTC Page

AKC.org

Google/Web Search

Breeder Referral

Friend

Other

Please list who referred you.

Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

How long have you lived at your current address?* This field is required.

Phone Number (Mobile)* This field is required.

Phone Number (Home)

E-mail* This field is required.

example@example.com

How do you prefer to be contacted?This is how we will contact you to proceed with your application.

Select the time of day you prefer to be contacted. (Select all that apply)* This field is required.

Morning (9am-11am)

Afternoon (12pm-4pm)

Evening (5-7pm)

No preference

Other

Select the day(s) you are available. (Select all that apply)* This field is required.

Any Weekday

Any Weekend Day

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

No preference

Other

What type of home do you live in?* This field is required.

Single Family Home

Duplex / Twin

Condo / Townhome

Mobile Home

Apartment

Other

Do you own or rent your home?* This field is required.

Own

Rent

Other

What is your landlord's name and phone number?* This field is required.

Do you have a fenced in yard or suitable pen to exercise your dog/puppy?* This field is required.

Yes

Other

Please explain how you plan to exercise your dog/puppy.

Do you have any children, or do you plan to have children in your house regularly (more than once per week)?* This field is required.

Yes

Other

Please list all household members (no pets here). * This field is required.

Please list relation and ages.

What is your household activity like on a day-to-day basis?* This field is required.

Does anyone in your household have any allergies?* This field is required.

Yes

If so, please explain.

Is everyone in the family aware of the possible addition of adding a dog/puppy to the household?* This field is required.

Yes

Explain why the whole household is not in agreement or aware of the dog/puppy.

Have you owned any pets in the past or currently?* This field is required.

Yes, I have owned and been responsible for pets before or currently.

No, this is my first pet.

Other

What aspects of your lifestyle do you feel would be of the MOST importance for your dog to fit in well with? For example, do you have grandchildren who visit on occasion, would your dog go to work with you and need to have excellent social skills, do you live in an active or loud home that could be frightening to a shy dog? etc.

Please list any pets that you have/had.* This field is required.Species/Breed? What is the age when you added them to your household? How old are they or how long did they live? What happened to them if they passed or why were they rehomed?

Have you ever rehomed a pet? (Including a shelter/rescue).* This field is required.

Yes

Please explain.* This field is required.

Have you ever returned a pet to their breeder?* This field is required.

Yes

Please explain.* This field is required.

What would you do if you could no longer keep the dog due to a reason beyond your control?* This field is required.

Pet puppies from Costerra are sold on a spay/neuter contract and limited registration (no breeding rights). Does this present a problem for you?* This field is required.

YESNO

Explain why this would be an issue for you.

Do you travel? If yes, what will you do with the dog when traveling?* This field is required.

Explain to us why you chose the Kerry Blue Terrier for you and your family!* This field is required.

How soon are you looking to add a dog/puppy to your household?* This field is required.(i.e., ASAP, within a few months, less than a year, more than a year, etc.)

Kerry Blue Terriers require professional grooming every 4-6 weeks. Is this a problem for you?* This field is required.

Describe the dog's diet (brand of dog food, supplements, treats, etc). Are you willing to consider our recommendations in regard to the dog's diet?* This field is required.

What type of home would you classify yours to be? Select all that apply.* This field is required.This is the type of activity that you are interested in doing with your new dog.

Companion/Pet home

Performance home (Competition in obedience, rally, FastCAT, barn hunt, etc.)

Conformation/Show home

Other

Are you interested in a male or female dog/puppy?* This field is required.

Female

Male

No preference

I prefer a female, but I am open to the right male

I prefer a male, but I am open to the right female

At what age do you prefer to get a dog/puppy at?* This field is required.

As early as possible

10-12 weeks

4- 6 months

6 months- 1 year old

Adult (>1 year old)

Other

How long will the dog/puppy be left alone at home at a time?* This field is required.

Explain how and where you will keep the dog/puppy during the day/night.* This field is required.

Do you plan on crate training?* This field is required.

Yes

If not crate training, how do you plan to contain your puppy when not home or in general?

Have you ever house trained a dog before?* This field is required.

Yes

Will you be attending any training classes?* This field is required.

Yes

If yes, please list and where at. If not, how do you plan to train your dog/puppy?* This field is required.

We love to hear places to suggest and hearing where our puppies will be educated!

Do you have a regular veterinarian? * This field is required.Stand-alone vaccination clinics and primary emergency centers are not acceptable forms of primary care. This is where you will take your pet for visits when you seek care for prevention and non-emergency care.

Yes

No, this is the first dog I have owned, and I plan to use this vet.

No (Provide most recent contact)

Veterinarian's Clinic Name* This field is required.

Veterinarian Phone Number* This field is required.

Veterinarian's Email

example@example.com

Clinic's Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Please list any other additional questions or comments here. We love hearing more about you! If there is anything else we should know, or just general comments you have please put them here!

Do you understand that though we will take your preferences into consideration, ultimately, we will select your puppy for you?* This field is required.

YESNO

Accept these terms to submit and finalize your applications.* This field is required.

I am aware that this application is not a guarantor for a dog/puppy from Costerra Kerry Blue Terriers, nor a contract of sale. This application has been filled out to the best of my knowledge and voluntarily. I am aware that at any time, Costerra Kerry Blue Terriers may decline my application with or without notice. If my application is accepted, I will be contacted and informed of next steps which may include phone interviews and home visits.

Costerra Kerry Blue Terrier - Dog/Puppy Application