Ayers Rock Kennel
Killingworth, Connecticut
Name: ______________________________________________________________________________
Address:_____________________________________________________________________________How long have you lived at this address:____________________________________________________
City: _________________________________________________________________________________
State: Zip Code:________________________________________________________________________
Phone Home, Cell, E-mail:________________________________________________________________
Best time to call AM or PM:______________________________________________________________
Have you ever owned a dog? Yes /No
Have you ever owned and raised a puppie? Yes / No
Are there other animals in your household?:_________________________________________________
What kind of animals and how many?:______________________________________________________
Will you be able to provide a safe, fenced, outside area for your pup? :____________________________
Do all family members want a puppie? :_____________________________________________________
How many family members in your home? Ages? :___________________________________________
Are there family members with known allergies to dogs? :______________________________________
Would shedding be a concern? Yes / No
Do you have a gender preference Yes / No?
If so please indicate male or female
Do you intend to use a crate for your dog after training is complete?:_____________________________
Describe your lifestyle active, more laid back, sedentary etc.:___________________________________
Will your puppy be alone for extended periods? :_____________________________________________
Name and contact information for your veterinarian (even if you currently have no pets, please list the vet you will using: ________________________________________________________________
You may mail or email your application for approval. Once approved a non-refundable deposit will be required to reserve your pup.
Mailing Address: Carole B. Pleines 628 Route 148 Killingworth, Ct 06419
carole@lifechallengesct.com
The balance is payable in full at the time of puppie selection/allocation at 7 weeks of age after temperament testing has been completed OR at any time after selection is made.
