NAME:____________________________________________________________

ADDRESS:_________________________________________________________

__________________________________________________________________

HOME PHONE:_______________________________________________________

WORK PHONE:_______________________________________________________

CELL PHONE:_______________________________________________________

EMAIL:____________________________________________________________

Please help me get to know you by answering the following questions. Even if you are a long-time dog person with lots of experience it will still be helpful to me to have the information in this questionnaire. You can ask me lots of questions, too! Thank you!

(1) I am interested in a Male/Female/Either:

(2) Please tell me about your goals for your puppy:

(3) Do you intend to eventually participate in any of the following activities with your puppy?

      Conformation:            Obedience:            Agility:            Herding:

      Tracking:            SAR:           Schutzhund:           Other:

(4) Describe any physical attributes that are especially important to you:

(5) Describe any character attributes that are especially important to you:

(6) Do you hope to breed Belgians? If yes, please explain:

(7) Where do you plan to take your puppy for classes?

(8) Please list the names of trainers you have worked with, plan to work with, or currently work with:

(9) Do you have any favorite dog training books? Dog trainers that you admire?

(10) Please list breed, registered name and any titles for each dogs you have owned or now own:  

(11) Please list the names of any breeders from whom you obtained previous dogs: 

(12) For current dogs living in your home, please also list ages and whether or not spayed/neutered:

(13) Please list types and numbers of non-dog pets you currently have in your home.

(14) How do you think your current dogs or other pets will interact with a new puppy? 

(15) How are your current dogs with strangers who come to the house? How about out of the house?

(16) How are your current dogs with dogs they don't know when out of the house?

(17) Please list the family members living in your home along with their names. Do you have children at home or visiting at regular intervals? If yes, please list sexes and ages:

(18) Do you have a fenced yard? If yes, please describe size, height, type and location of the fence and yard:

(19) Do you or your neighbors have livestock? If yes, what's the fencing setup?

(20) What kind of work do you do? How do you envision a puppy fitting into your work schedule?

(21) How long each day will the puppy be alone? Where will the puppy be while you are away during the day?

(22) Where will the puppy sleep?

(23) What will you do with your puppy when you go on a vacation?

(24) Do you have a veterinarian you will be using for your puppy?

      Veterinarian:

      Clinic:

      Address:

      Phone:

(25) Do you belong to any dog clubs? Please list:

(26) How do you envision your relationship with your dog breeder?

(27) Are you willing to stay in contact with photos and news?

(28) May I, or my representative visit your home?

(29) In the event that you purchase a Montage Belgian, please print the exact spelling of owner's name(s) as it should appear on the registration papers:

      Owner(s):

(30) How did you hear about Montage Belgians?

REFERENCES: It's a small world. Do I know anyone you know? If not, that's okay but I hope you won't mind providing the names, addresses, phone numbers and emails of at least two references who would be able to recommend you.

Name:____________________________________________________________

      Address:_________________________________________________________

      __________________________________________________________________

      Phone:____________________________________________________________

      Email:____________________________________________________________

      Relationship to you:_______________________________________________

Name:____________________________________________________________

      Address:_________________________________________________________

      __________________________________________________________________

      Phone:____________________________________________________________

      Email:____________________________________________________________

      Relationship to you:_______________________________________________

Name:____________________________________________________________

      Address:_________________________________________________________

      __________________________________________________________________

      Phone:____________________________________________________________

      Email:____________________________________________________________

      Relationship to you:_______________________________________________