Dakota Dalmatians Application
Your Name _______________________________________ Phone __________________
Address __________________________________________________________________
City _______________________________ State ___________ Zip Code _____________
Email Address ______________________________________ Alt. Phone ______________
How did you learn about our Dalmatians? ________________________________________
Check you preference:
Puppy _____
Adult ________ ////// Male
______ Female _______
For what purpose do you wish to obtain a Dalmatian? (check all that apply)
Companion
____ Show _____
Obedience/Agility _______ Protection
______
Other
______________________________________________________________________
Do you have a color preference? __________ If yes, black/white ____ or liver/white _____
Have you previously owned a Dal? ______ Present Pets _______________________________
Previously Owned Pets: __________________________________________________________
What happened to them? _________________________________________________________
Have you ever had to put a dog to sleep (euthanized)? If so, why? ___________________________
Do you have a problem with neutering/spaying this Dal? ________________________________
If so, can you explain why? ___________________________________________________________
HOUSEHOLD:
Are you M S D W (Circle) Your age ______ Children at home/Ages:__________________
Occupation of adults ____________________________________________________________
Who will be the PRIMARY CARETAKER of this dog? ________________________________
Where will the dog be during the day? ____________________ At night? _________________
Do you reside in the (Circle) City ____ Suburbs ________ Country _______
Do you live in a (Circle) House ______ Apartment _________ Townhouse _________
Do you have a fenced yard, dog run or other area? Please comment: _______________________
______________________________________________________________________________