Quail Run Cavaliers
Linda Kornhi
541-726-3850
Name:_________________________________________
Home phone:______________
Spouses Name:___________________________________________________________
Address:_______________________________________City:____________________
State:_______Zip:________Work phone:________________Fax:___________________
Email address:_______________________________
Occupation:______________________
Best time to call:__________________________
Spouses Occupation:______________________________________________________
Do you live in a: house, apartment, trailer, other_________________________________
Do you own or rent your home?___________If you rent do you have landlord's
permission to keep a dog?_______Landlord's name and phone number:_______________
______________________________________________________________________
If less than one year give previous address:______________________________________
______________________________________________________________________
Do you have a fenced yard?__________
If no fence how will you handle toilet duties?__________________________________________________________________
Do you understand these are house dogs, and are NOT to be housed outdoors? Initials___
How many adults in household?_____________
How many children?_________________
Age & sex of children?___________________
Have you owned a Cavalier before?______
If not, how did you learn of this breed and why do you want this breed?___________________________________________________________________
Do you currently own Cavaliers or dogs of other breeds?__________________________
If yes, list breed, sex and age:________________________________________________
____________________________Have you ever owned Cavaliers or dogs of other breeds?________________
What breeds?________________How long?_________________What happened to
them?__________________________________________________________________
Do you own cats?__________How many?____________How long?_________________
Where will the Cavalier spend the day? (Circle all that apply) loose indoors, loose outdoors, basement, garage, fenced yard, tied up outdoors, kennel run, crate, bathroom, other________________________________________________________________
Where will the Cavalier spend the night? (Circle all that apply) loose indoors, loose outdoors, basement, garage, fenced yard, tied up outdoors, kennel run, crate, bathroom, other_________________________________________________________________
What activities do you plan to engage in with the Cavalier? (Circle all that apply) walking, jogging, running, obedience, rally, agility, conformation showing, therapy work, traveling,
other _________________________________________________________________________
On the average, how many hours a day will the Cavalier be alone?_______________
Do you have a regular Veterinarian?________
Name, address and phone:____________
I give permission to call my Veterinarian for a reference. Initials_________
Do you understand that pet Cavaliers are sold on a spay/neuter contract and ARE NOT TO BE USED FOR BREEDING? Initials_________
What are your reasons for wanting a Cavalier? (Circle all that apply) children's dog, companionship, guard dog, watch dog, other____________________________________
Do you agree to contact Linda Kornhi if you can no longer keep or care for this Cavalier, and relinquish the dog only to her?______________________________________________________
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ALL OF THE INFORMATION I HAVE GIVEN ABOVE IS TRUE AND CORRECT. I AGREE TO PROVIDE THIS DOG WITH PROPER AND SUFFICIENT FOOD, WATER, SHELTER, TRAINING, MEDICAL CARE, COMPANIONSHIP AND HUMANE TREATMENT AT ALL TIMES. I FURTHER AGREE THAT LINDA KORNHI AND QUAIL RUN CAVALIERS IS IN NO WAY
LIABLE OR RESPONSIBLE FOR ANY DAMAGE, ACCIDENT OR INJURY RESULTING FROM THE PLACEMENT OF A DOG INTO MY HOUSEHOLD.
WE RESERVE THE RIGHT TO REFUSE ANY PERSON OR PERSONS FROM ADOPTING ONE OF OUR CAVALIERS.
By:_________________________________________Date:_______________________
Signature
Quail Run Cavaliers
Revised 5/2007
Copyright 2007
No part of this application may be duplicated without written permission of the site owner.
