The following information is provided in consideration for the possible purchase of a Dalmatian puppy from Kila K Shepherd of Dashing Dalmatians ("Breeder").  Submission of this application in no way guarantees placement of a Dalmatian puppy by Breeder in the applicant's home.  The information contained herein will be used for the sole purpose of determining the applicant's suitablility with regard to Dalmatian ownership.

Personal Information:

Name(s):

Street Address:

State:

Zip:

City:

Cell

Home Phone:

Work Phone:

e-mail address:

Please indicate your puppy preference:

No Preference Yes No

No Preference Black and White Liver and White

Do you have a color preference ?

No Preference Male Female

Would you like a patched puppy?

What gender do you want?

No Preference Yes No

Is one or more blue eye(s) acceptable?

What activities are you planning for your Dalmatian? Companionship, Performance (Obedience, Agility, Tracking, Road Trials), Showing (Conformation), Breeding, etc.  Please list all that apply:

Please tell me about yourself:

No Yes

If "Yes", please explain:

Have you ever been charged or convicted of animal abuse or neglect?

Own Rent/Lease

Do you own or rent/lease your home?

If you rent/lease, please provide your landlord's contact information:

Yes No

Do you have children under the age of 18 living at your home either full-time or part-time?

If "Yes", please list their ages:

Describe your yard (size, type and size of fence, shelter/structures, shade, etc.:

Yes No

Have you ever owned a Dalmatian before?

If "Yes", please tell me about him/her/them (ages, spayed/neutered, if deceased when, why, and did you own at the time of death, etc.)

Yes No

Have you ever owned a dog of any other breed before?

If "Yes", please tell me about him/her/them (ages, spayed/neutered, if deceased when, why, and did you own at the time of death, etc.)

Please provide your Veterinarian's name, address, and phone number:

Have you ever surrendered a dog you owned to a shelter or other similar organization (breed rescue)?

Yes No

If "Yes", please explain:

How much time each day can/will you spend with your Dalmatian?

Describe where your Dal will be kept while you are away from home (at work, out to dinner, etc.):

Where will your Dalmatian sleep (describe location, bedding, etc.)?

Yes No

Are you willing to go to Obedience classes?

Yes No

Have you ever raised a puppy?

Does anyone who lives at/frequents your home have allergies?

Yes No

Yes No

Is anyone in your home concerned with white hairs on carpets, furniture, clothing?

Consent/Agreement:

By indication below, I confirm that I am at least 18 years old and that the above information is true, and correct to the best of my knowledge.  I hold Breeder harmless in the event unfavorable information is discovered while processing this application.

I agree and consent I do not agree or consent