Are you interested in a male ____________ or female______________

Have you ever owned a hunting dog before? Yes:  ____________  No:____________ If yes which Breed:_____________________________________________________

Please list the species of upland hunting you enjoy: Pheasants____________________   Quail_______________________   Chukar_____________________   Woodcock__________________   Grouse____________________   Other_____________________ Do you hunt: Duck______________________   Goose:____________________

Will you train the dog yourself _________________ or send the dog to a trainer__________________

Will the pup live in the home________________ or outside_________________     Will the puppy be crated during the day______________ How many hours __________

Are you married ______________ single________________   Number of Children living at home__________________________

Do you own a home ____________________

Do you currently belong to the following organizations: NADKC___________________   NAVHDA_________________   Other___________________

Are you aware of the financial responsibilites that come with owning a hunting dog Yes____________ No___________

Name:_________________________   Address:_______________________   City:_________________________  State_________________ Zip Code_____________________   Home Phone:____________________________  Mobile Phone_____________________________   Email:__________________________________________________________________________   Comments: