Puppy Application. Relationship to Applicant Home Address City State Zip . Do you plan on showing this puppy?

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1 Puppy Application Name of Applicant Age Name of Co-Applicant Age Relationship to Applicant Home Address City State Zip Home Phone Work Phone Best time to contact Why do you want an Irish Terrier? Do you plan on showing this puppy? Yes No Don t Know In: Conformation Agility Obedience Other How did you learn about DUNLOE IRISH TERRIERS? Do you prefer Male Female Does not matter Name and number for veterinarian who you have used or plan to use: Page 1

2 Previous Experiences: Will this be your first dog? Your first Irish Terrier? If other Irish Terrier, who was the breeder? Other breeds you have owned? List any pets you have and if they have been spayed/neutered: Spayed/neutered Yes No Spayed/neutered Yes No Have you ever bred a dog? Yes No Do you plan to breed Irish Terriers? Yes No Have you ever sold, given away or surrendered a pet? Yes No Please describe circumstances Have you ever had a pet die because of illness, or accident? Yes No Please explain Environment: Number of Children at home? Please list names and ages Are there any persons living at home with disabilities that may adversely affect the care of the dog? Yes No If yes, describe Do you live in a House Townhouse Apartment Other Do you Own Rent If rent, pets permitted? Do you have a fenced yard? How high? Approximate dimensions Type of fence Is your yard chemically treated? Yes No Page 2

3 Puppy Care: Where will pet be during the day? At night? Is anyone home during the day? Who? Who will be responsible for the care of the animal? Will your dog: o Have the run of the house? Yes No o Be in a blocked off part? Yes No o Use a crate? Yes No o Live in the yard? Yes No o Be allowed on the furniture and/or bed? Yes No o Be walked daily? Yes No o Exercised in a fenced yard? Yes No o Allowed to run free? o What Brand of Dog Food will you feed? Are you: o Familiar with the use of a dog crate to train and/or confine the dog when you are not there? Yes No o Willing to crate train? Yes No o Aware that Irish Terriers are active dogs? Yes No o Aware that Irish Terriers are aggressive dogs? Yes No o Willing you groom the dog yourself? Yes No o Willing to take the dog to a Groomer? Yes No o Do you plan to take an obedience course? Yes No o Have you ever taken an obedience course? Yes No o Sure all members of the family want this dog? Yes No o Aware that the routine costs of maintaining a dog average o $800 - $1000 per year? Yes No These are based on Veterinary care and feeding a Super Premium Food When Traveling on Vacation the Irish Terrier will Page 3

4 Please provide contact information of three references. Reference 1 Name Address City Phone: AM PM Best Time To Call Relationship Reference 2 Name Address City Phone: AM PM Best Time To Call Relationship Reference 3 Name Address City Phone: AM PM Best Time To Call Relationship Please Be Advised these people will be contacted Page 4

5 I acknowledge that all information provided on the application is correct and true. I understand that any misrepresentation of fact may result in my not qualifying for a Dunloe Irish Terrier. I also understand that the completion of this form does not automatically qualify me for a Dunloe Irish Terrier but is only the first step in a continuing process. I understand that a required phone and in person interview will be the next step and that a visitation by all members of my household whether they involved in direct puppy/dog care. I also swear and certify that I or any member of my household has NEVER been charged with or convicted of animal cruelty or neglect. APPLICANTS SIGNATURE Date CO-APPLICANTS SIGNATURE Date Please return completed and signed application to; Dunloe Irish Terriers C/o Amy L. Dieter 1423 Brunnerville Rd. Lititz, PA Or tobfferry@ptd.net Type - Dunloe Application in Subject line. Page 5

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