Melody Kennels Questionnaire

Puppy and Dog Questionnaire

Thank you for your interest in a Melody Dalmatian! By filling out this questionnaire as completely as possible, you will help us find the right dog for you. Please note that this form is not a reservation or guarantee of a puppy or dog. Melody Kennels reserves the right to make the final decision on the sale or transfer of puppies and dogs.

Full Name
Spouse/Partner Name
Age
Street Address
City	State (for Canada, enter CAN) Zip
Phone Home:	Work: Cell:
Email Home:	Work:
Best Time to Call:

How did you hear of Melody Kennels? Dal Owner Advertisement Web Other

Why do you want to own a Dalmatian?

Please specify what age/sex/color of Dalmatian you are looking for (if you have a preference):

Do you consider yourself/family to be active in such a way that it would include your Dalmatian? How?

Have you ever owned a Dalmatian? Yes No

Do you have other dogs now? Yes No If Yes, please answer the next section:

What breed(s), sex(es), and age(s)?

How often are they fed? Watered or dry? Watered Dry Brand:

How do your dogs get along with other dogs? Excellent Good Fair Poor

Is/are your dog(s) neutered or spayed? Yes No

Have you ever bred a litter? Yes No

Have you ever trained in obedience? Yes No Willing to train in obedience? Yes No

Do you own cats? Yes No

How many? Are they used to dogs? Yes No

Do they live indoors or out? Indoors Outdoors

What other animals are in the house, i.e., rabbits, gerbils, hamsters, ferrets, etc.:

Previous pets (dogs/cats) owned:

What happened to them?

Veterinarian Information:
Do you have a veterinary reference? Yes No If yes, please complete Veterinarian info below.
If no, please indicate the reason:

Veterinarian Name:
Address:
Phone:

Personal Reference #1 Information:

Name:
Address:
Phone:
Email:

Personal Reference #2 Information:

Name:
Address:
Phone:
Email:

Do you have a fenced yard?

Fence height (ft): Fence type

If "Other", please explain fence type:

Is fence completely enclosed on all sides and also attached to the house? Yes No

What kind of shade or cover is in the enclosure?

Please describe your yard, including approximate size, level or hilly, grass or other ground cover, etc.

What kind of accommodations do you have for the dog in the cold and in the heat?

Is anyone home during the day? Yes No Hours the dog would be alone

Where will the dog stay during the day when alone?

Do you have a dog door? Yes No

If you have a dog door, does it go into the house or garage? House Garage

Describe neighbors the dog will be involved with (Do they like dogs? Children (ages), dogs or cats?)

Any problems with neighbors currently? Yes No

Do you own your home? Yes No

If not, please send a letter of permission from your landlord to have a Dalmatian.
Give landlord's name, address, and phone number.

What do you do with your pets when you go on vacation?

Do you own and have you used a dog crate? Yes No

How old are any children who will be in contact with the dog?

Does anyone in your family have asthma, or allergies to cats? Yes No

If yes, how severe?

Do all parties (if more than one adult in house) want a Dalmatian? Yes No

Any other questions about the breed we can answer?