Name

First Name

Last Name

Spouse/Partner Name

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you own this home? *

Yes

No

Do you have children? *

Yes

No

If you do not have any children, do you plan on having any in the future? *

Yes

No

Employer Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Spouse/Partner's Employer's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have a dog crate? *

Yes

No

Is your yard fenced or do you have a containment system? *

Option 1

Option 2

Why are you choosing a PWD? Check all that apply. *

Family Pet

Obedience Training

Show/Breeding Dog

Therapy Dog

Agility

Water work

Other

Are you willing to spay/neuter this puppy at the recommended age? *

Yes

No

Do you have a gender preference? *

Male

Femail

No Preference

Do you agree to have your Portuguese Water Dog current on all annual checkups and all vaccinations? *

Yes

No

Do you have a hair type preference? *

Curly

Wavy

No Preference

If you no longer continue to keep your Portuguese Water Dog you purchased through us, you understand that you MUST RETURN THE PWD TO US. NO ONE ELSE IS TO HAVE THIS PWD IF YOU ARE UNABLE TO KEEP THEM AT ANY POINT IN THE FUTURE. *

YES, I UNDERSTAND AND AGREE TO THIS

NO