CEMANI PRESERVE INTAKE FORM
Prospective Cemani Owner Questionnaire
SECTION 1 — Basic Information
Please provide your contact and background information.
Full Name
*
First Name
Last Name
Farm / Flock Name (if applicable)
City & State
*
Email
*
example@example.com
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Social Media (if you share your birds publicly)
How did you hear about The Cemani Preserve? List any referrals by first and last name.
SECTION 2 — Experience Level
Tell us about your poultry experience.
How many years have you been raising poultry?
*
0–1 year
2–5 years
5–10 years
10+ years
What breeds do you currently raise?
*
Are you currently a member of any poultry organizations? If so, which one(s) and for how many years?
*
Have you raised rare or heritage breeds before?
*
Yes
No
Have you ever owned an Ayam Cemani?
*
Yes
No
Are you familiar with incubating, using incubators and incubation?
*
Yes
No
Have you ever exhibited birds?
*
APA Sanctioned Shows
Local shows only
No showing experience
Are you familiar with fibromelanosis genetics (Fm locus)?
*
Yes — advanced understanding
Basic understanding
Not familiar
Have you worked with line breeding or structured breeding programs?
*
Yes
No
SECTION 3 — Intent & Goals
Share your goals and interests regarding Ayam Cemani.
What is your primary reason for purchasing Ayam Cemani?
*
Pets
Exhibition / APA goals
Breeding program development
Genetic research interest
What are you looking for?
*
Hatching eggs (NOT OFFERED BY THE CEMANI PRESERVE)
Chicks (NOT OFFERED BY THE CEMANI PRESERVE)
Grow-outs 5-7 MONTH OLDS
Adults 10-12 MONTH OLDS
Proven breeding pairs
Trio
Partnership / Co-Ownership opportunity
Do you intend to resell offspring?
*
No
Yes - locally
Yes- nationally
Yes - online sales
What are your long-term goals with the breed? (3–5 year vision)
*
SECTION 4 — Biosecurity & Management
Describe your flock management and biosecurity practices.
Do you currently practice flock biosecurity protocols?
*
Closed flock
Quarantine procedures
Regular health testing
None
Do you mix breeds in the same enclosure?
*
Yes
No
How many total birds are currently on your property?
*
Describe your housing setup (free range, tractors, pens, climate controlled, etc.)
*
Do you vaccinate your flock?
*
Yes
No
Are you willing to follow structured pairing recommendations?
*
Yes
Maybe
No
SECTION 5 — Breed Understanding
Demonstrate your understanding of the breed.
What do you believe defines correct Ayam Cemani type?
*
Are you aware that: Fibromelanosis alone does NOT define quality? Type, structure, and conformity matter? Incorrect American silhouettes are currently widespread? (Short response)
*
What is your understanding of: Proper body carriage? Leg length & proportion? Comb and wattles structure? Skin pigmentation depth?
*
Would you be open to lab verification testing?
*
Yes
No
Depends on cost
SECTION 6 — Commitment & Ethics
Your ethical commitments and willingness to follow breed standards.
Do you plan to crossbreed any of your Ayam Cemani with any other breeds? If so, which breeds?
*
Would you be willing to sign a breeding agreement?
*
Yes
No
Would you share pricing information publicly?
*
No
Yes
Are you comfortable with: Culling for type? Selecting for structure over color? Removing non-conforming birds from breeding pens?
*
Why should you be entrusted with preserving this breed?
*
SECTION 7 — Advanced (For Exhibition or Partnership Tier)
For those interested in exhibition or partnership opportunities.
Are you willing to maintain line integrity and track pedigrees?
*
Yes
No
Would you participate in collaborative genetic data sharing?
*
Yes
No
Are you interested in:
*
Homozygous testing validation
Phenotype scoring sheets
Structured breeding charts
Are you open to joint marketing standards under The Cemani Preserve name?
*
Yes
No
Are you ready to receive pricing?
*
Yes
No
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