Please complete and return the following questionnaire. This will assist us in the selection of an appropriate puppy for you and your famiIy.
	Name:		Phone:
	Email:		Fax:
	Address:		City:
	State:		Zip:
	How many people are in your household?
	Do you have children? Yes No
	If yes, what are their ages? (seperate each age with comma)
	Does every family member want a dog? Yes No
	If not; please explain
	Who will be responsible for caring for the dog and what is their general home/work schedule?
	What made you decide to get a dog, and particularly, a Portuguese Water Dog?
	What activities do you participate in for pleasure?
	For what purpose  are you purchasing a  Portuqaese Water Dog? (Check all that apply to you)
	Family Pet Obedience Training Show/Breeding Therapy Dog Agility Water Work Other           Other, please explain:
	Do you have experience in raising and training a puppy?