Name:

E-mail Address:

Street Address:

City/State/Zip:

Home Phone:

Business Phone (optional)

Age:     18-40          40-65           65 or older

Number of other adults in your household:  

Number & ages of children:

How many hours per day will this dog be left alone?

1-3         3-6          6-8         more than 8       

If more than 8 hours, will someone be able to "potty" the puppy at lunch, or will you hire a dog walker?  

Lunch Potty         Dog Walker

Where will the dog be when no one is home - loose/crated or confined to kitchen/basement/garage/yard?

Where will the dog sleep at night - on the bed/loose/crated or confined to kitchen/basement/garage yard?

What would you do with the dog if you suddenly found yourself unable to keep it? (things do happen!)

Do you have any dogs now?   Yes       No

If yes, please list their breeds and ages:

List any other pets you currently own:

What problems (health, training, behavior, etc) if any did you have with previous dogs? (be specific):

Have you ever taken a dog to obedience classes?   Yes       No

Do you plan on taking this puppy to an obedience class?   Yes     No

Have you ever owned an English Cocker before? Yes       No

If yes, from whom did you purchase them, and how long did you have them?

If no, what are your reasons for choosing one now?

Are you looking for a puppy now, or in the future (explain)?

What traits are you looking for in a dog?

Do you prefer a male or a female?

Male     Female

Would you consider either sex if your preference was not available?

Yes No

What is your color preference, if any? Select one only.
(Please be aware, that Stargate English Cocker Spaniels is breeding specifically for breed type & quality in parti colors & roans.
Generally a litter will produce one or two colors.)

Therefore not all colors listed below will be readily available

Black & White

Black, White & Tan

Liver Roan

Liver Roan & Tan 

Orange & White

Orange Roan 

Blue Roan  

Blue Roan & Tan 

No Preference

Other Color, Please explain or describe below.

Would you consider another color if your preference was not available?

Yes   No

Would you consider an older puppy or an adult dog?

Yes     No     Possibly

If yes or possibly, what is the maximum age you would consider?

1-2 Years     2-4 Years     4-6 Years     6-8 Years 

Do you rent or own your own residence?

Rent         Own

Is your yard fenced or do you have a fenced enclosure for the dog?

If not, how do you intend on controlling the puppy?

How much daily exercise do you plan on giving?

How long do you expect housebreaking to take?

Where will the dog PRIMARILY spend it's time?

Inside     Outside     Both

Reason for wanting a dog:  

Pet     Show     Obedience Agility Breeding Hunting Tracking Other, explain below.

If 'other' or a combination of 2 or more reasons, please explain:

Do you currently have a veterinarian?

Yes       No

If yes, please provide name, address and phone # of veterinarian:

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