Date: 

Litter of Interest:  

Your Name: 

Co-owner, if any 

Street Address: 
City:    State (or Country):    Zip Code: 

Phone Number - Home:      Work: 
E-Mail Address: 

Family Status:  Single     Married - Spouse Name:
Children Living at Home:  Yes     No
Names and Ages:

Limited Registration means that the Puppy is registered but no litters produced by this puppy are eligible for registration. This AKC procedure helps protect established breeding programs. These dogs can be shown in obedience trials, field trials, and hunt tests.

All pups are now being sold with Limited Registration only. See contract for requirements to change to Full Registration. If for some reason full registration is needed i.e. foreign registration, Please contact me for arrangements.

Type of Registration  limited   

Will Pup be Spayed/Neutered  yes  no 

Sex  male  female 
Will You Take Other Sex  yes  no   

Color Preferred  indifferent  light  medium gold  red  dark red 

Do/will your dog(s) live:  In Home    Outside       Fenced Yard    Kennel
    Other:  

Plans for your Puppy - Check all applicable:     Pet/Companion     Hunting
    Hunt Test     Obedience    Field Trial    Agility    Search & Rescue    Conformation
    Other 

Training:
Do you anticipate sending your puppy away to a pro for training.     Yes  or   No

Professional Trainer's Name: 

Will Pup need to be shipped  yes  no 
Nearest Large City to Ship Into 

Canine Experience:  List dogs currently owned including call name, breed, and titles (if any):

List dogs previously owned and disposition of each:

List any dog clubs you are a member of, or participate in:

Use the space below to add any other information you would like me to know about you, or any other comments: