The following information is provided in consideration for a puppy from Smiling
Dalmatians.
Name(s)
Street
Address
City
Zip
State
Home Phone
Work Phone
Cell Phone
Email Address
Please indicate your puppy
preference
Gender
Color
Is a patch acceptable?
Are blue eyes acceptable?
What activities are you planning for your Dalmatian? Conformation,
perfornamce, breeding, etc. List all that apply.
Are you willing to spay or neuter?
Please tell me about
yourself
Have you ever been charged or convicted of animal abuse or neglect?
If yes, please explain
Do you own/rent/lease your home?
If you rent/lease, please provide your landlord's contact information.
Do you have any children living in your home under the age of 18, 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.)
Have you ever owned a Dalmatian before?
If yes, please tell me about him/her/them (ages, if neutered. If deceased, when, why and did you own at time of
death, etc?)
Have you ever owned a dog of any other breed before?
If yes, please tell me about him/her/them (ages, if neutered. If deceased, when, why and did you own at
time of death, etc?)
Please provide your veterinarian's name, address and phone number.
Have you ever surrendered a dog to a shelter or rescue organization?
If yes, please explain.
How much time each day can /will you spend with your Dalmatian?
Describe where your Dal will be kept when you are away from home, at work, out to dinner, etc?
Where will your Dalmatian sleep? Describe location, bedding, etc.
Have you ever raised a puppy?
Are you willing to go to obedience classes?
Does anyone who lives at or frequents your home have allergies?
Is anyone in your home concerned with white hairs on furniture, carpets, clothing, etc?
Consent/agreement
By indicating 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.