Name:

Email Address:

Phone Number:

Street Address

City

Province or State

Postal Code

You are looking for a (please underline one): Male Female

This dog is to be a (please underline all that apply): Show dog Working dog Companion Only

This dog will be active in(Please underline all that apply): Conformation Obedience Agility

Tracking Therapy Other (please explain)

What are the qualities you are looking for in a Rottweiler?

What are your goals for this dog?

How many adults live in your family?

How many children are in your family?

What are the children's ages?

How many dogs live with you now?

What other pets do you have?

Tell us about your lifestyle, work schedules, etc.

Do you have the time and resources and are you willing to take obedience
courses?

What area do you live in(please underline one)? City Ru rel

Do you (please underline one): Own Rent

Where will the dog live?(please underline one): Indoors Outdoors

Will the dog have access to a fenced yard? (please underline one) Yes No

Tell us about your experience with dogs.  List all the dogs you have owned
and what happened to them.

List any dog clubs you belong to. 

List any titles you and your dogs have achieved.

Please provide us with two references.  If you have previously owned a dog,
one of the references must be a breeder, veterinarian, or trainer.

Please include any other information that you wish us to have.

Are you willing to travel to Howden Manitoba to pick up your puppy?