Name *
Address *
City *
State *	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Phone Number *
Email Address *
Do you own or rent your home?*	Own Rent
Do you have a fenced yard?*	Yes No
If you do not have a fenced yard, how will you handle house training?
Who will be the primary caregiver for the puppy? *
How many hours per day, on average, will the puppy be left alone?*
Is someone available to feed and exercise the puppy while you are away? Explain.*
Where will the puppy be kept during the day? at night?*
Do you have children? If yes, how old? *
Does anyone in your household have allergies to animals?* *	Yes No
Have you ever owned a Cavalier or other dog before?*	Yes No
If you currently do not own any pets, can you please tell me of any past experience with dog exposure and/or dog ownership?
Do you own any other type of animal? If so, please list: *
Have you ever had to return or rehome a dog or other pet due to problems or personal changes in your life? If yes, please explain. *
Have you read any books or other information about Cavaliers?*
Are you familiar with the health problems that Cavaliers can be afflicted with?*	Yes No
Are you aware that spaying or neutering is part of the contract? Do you have any questions or concerns regarding this?*
What gender would you prefer? (male/female)*
What color would you prefer? (blenheim, tri-color, ruby, black & tan)*
We do not ship puppies. If you are out of state, are you willing to travel to pick up your new puppy?*
Any other comments or concerns: