Name:
Address:
City:
Province:
Phone:
Email address:
Explain why you have chosen a PWD to purchase?
Have you ever owned a PWD before?	Yes No
What preference are you looking for?	Male Female
What type of PWD coat do you prefer?	Wavy Curly
Do you have a color preference?	Yes No
Do any family members have any type of allergies to dogs?	Yes No
Do you live in a	House Townhouse Condominium Apartment
Do you have a yard completely fenced with secure fencing?	Yes No
Do you currently own any other pets?	Yes No
Do you have children in the home?	Yes No
If you do have children what ages are they:	1-5 5-10 10-20
Would someone be home with the dog during the day?	Yes No
How many hours would the puppy be alone?	1-3 3-7 7-10
Would someone be letting the puppy out at lunchtime?	Yes No
Are you willing to crate train your puppy?	Yes No
Are you willing to take your puppy to puppy class?	Yes No