Name:
Email address: (Will be kept private)
Are you interested in an available puppy or would you like to be placed on the waiting list?	Waiting list for future litter - Male Waiting list for future litter - Female
If you have children, what are their ages?	1 - 3 yrs. 4 - 6 yrs. 7 - 10 yrs.
How many hours a day will your puppy be alone?	0 1 2 3 4 5 6 7 8 9 +
Do you have a fenced in back yard?	Yes No
Do you have other pets, if so what are they?
Have you owned a small breed dog before?	Yes No
Are you a breeder?	Yes No
Do you have any questions or comments for us?