* Please provide the name and ages of persons in your household.

* Please list other pets in your home including their ages.

Please list any preferences: male/female, show/pet quality, color, age, etc.

* Where will your dog live (indoors, outdoors, etc.)? How will this dog be confined outdoors (i.e. fenced yard, kennel, cable run, tether)?

* Who will be the primary caregiver for this dog?

On average, how many hours will this dog be alone during the day?

If you decide on a pet Havanese, are you aware that it will be sold with limited registration on a spay/neuter agreement?
Yes llllllll No

Timing - When would you like to add a dog to your family?

How did you become introduced to this breed and what characteristics do you find the most appealing?

What activities are you interested in doing with your dog- conformation, obedience, agility, rally, flyball, therapy, etc.?

If there is not a dog currently available, would you like to be placed on a waiting list?
Yes llllllll No

* Your Name

* Your Address

* Your telephone number and/or email address