Puppy Application

First name

Last name

Email

Phone

Alt. Phone

Multi-line address

Country/Region

Address

Address - line 2

City

Zip / Postal code

State

Living situation

Location of Dwelling

Rural

City

Small Town

Do you rent or own?

Rent

Own

If you rent, are you planning to purchase your own home in the near future?

Yes

No

If you are renting, do you have your landlord's permission to own a dog?

Yes

No

Can you provide a letter stating such from your landlord?

Yes

No

Work History

Occupation

How long?

Family Information

Please enter ages of children, separated by a comma

Are they comfortable around dogs?

Yes

No

If no, have they had a bad experience around dogs?

Yes

No

Does anyone in the household have allergies to dogs?

Yes

No

Does everyone in your household want to get a Cocker Spaniel?

Yes

No

Can you provide us with references if we should ask for them?

Yes

No

Dog Experience

Do you currently own a dog?

Yes

No

If yes, how many and what breed(s)?

Are there any other pets in the home? (cats, hamsters, etc.)

Yes

No

If yes, how many and what type(s)?

Do you have previous dog ownership experience?

Yes

No

Is proper veterinary care and a high quality diet a priority?

Yes

No

Are you concerned about the health and over-vaccination in pets?

Yes

No

Are you willing to follow the vaccination protocol recommended by the breeder?

Yes

No

Do you have a preference of puppy gender?

Male

Female

I'm happy with either (no preference)

Color preference

Are you planning to add any other pets to your home in the near future?

Yes

No

Maybe

If yes, what kind and how many?

Why a Cocker Spaniel?

What made you choose a Cocker Spaniel?

What do you like about a Cocker Spaniel?

Have you met a Cocker Spaniel in person?

Yes

No

What kind of energy level are you looking for?

High

Medium

Low

Will this dog live at the supplied address?

Yes

No

Where will this dog spend most of its time?

In the house

Fenced yard

Outdoor kennel

Tied up outside

Where will this dog generally spend its time when you are working or away from home?

With me

At home inside

At home outside

Do you have a fenced yard?

Yes

No

Not currently, but I plan to

If yes, how large is the fenced area?

If no, how do you plan to manage your dog's outdoor time?

How much time would the dog normally spend alone at home each day?

0-3 hours

3-5 hours

5-8 hours

8 or more hours

How many days a week would the dog be home alone?

Are you currently on a waiting list from another Cocker breeder?

Yes

No

Any additional thoughts/comments:

Thank you for taking the time to answer the questions in our application. By providing us with this information, we hope to better understand why you want to add a Cocker Spaniel to your home, and if we have a Cocker Spaniel that will fit your needs. All information is treated with the upmost confidentiality and will not be passed along to anyone without your permission.

Debra Allen - Justice Kennels - established 1990