Do you want to reserve a puppy from a specific litter? Yes___ No____ if yes, which one ______________

Please circle your preferences below and or indicate with order of preference

Gender: No preference Male Female Important Not Sure

Please list the physical characteristics of the Boston Terrier that are most important to you.　

Please list the temperament or personality characteristics that are most important to you.　

Why do you feel that the Boston Terrier is the right breed for you and or your family?

Will this be your First Boston Terrier? Yes___ No___

Do you have other animals? Yes___ No___ If yes, list some information about each one..

Tell me about your family, # of adults in household, # of children if any, age of each child.　

Which family member will be primarily responsible for your new puppy?

Tell me about the activities that you and your family enjoys, such as hiking, camping, fishing water-sports gardening, running, biking etc…　

What kind of activities do you want your new puppy to participate in?　

What is your plan for the care of you new puppy when you and other family members are away from the house for long periods of time?　

Tell me about your yard, and or area where the puppy will exercise and play.

What kind of fencing if any do you have?

Where will the puppy sleep?

What is your plan for the training of your new puppy?　

Which family member will be responsible for the training?

What is your plan for grooming, do you wish to learn to do this yourself or take your puppy to a groomer?

(nails, ear cleaning, occasional bath)　

Do you have an established Veterinarian? Yes___ No___ Please list the name, address and phone # of your Veterinarian. May we contact them for a reference? Yes___ No___　

I have read and answered all of the above questions truthfully and to the best of my knowledge.　

Signature _______________________________________ Date _________________________　

Signature _______________________________________ Date _________________________