About you:

Name
Address
City
State
Zip
Day Phone
Eve Phone
E-mail

Your occupation: 

Your age:  Select one: 18-40 41-65 66+

Number of adults in your household:  Select one: 1 2 3+

Number of children in your household (include visitation, day care):  Select one: 0 1 2 3 4 5+

Age of youngest child:  Select one: infant to 2 yrs 3-5 6-9 10+

Please describe your living situation, checking all that apply:

House     Apartment     Condo/townhouse
Suburban     Urban     Rural
Own     Rent
Fenced yard     Unfenced yard
Private yard      Complex yard     No yard; will walk dog

Where will you exercise the dog?  Select one: fenced yard unfenced yard no yard -- I will walk dog

How many hours per day will the dog be left alone?  Select one: 1-3 4-8 9+

If the dog will be alone for 6 hours or more, will he be let out midday?  Select one: Yes No Sometimes

Where will the dog be when nobody is home?  Select one: Indoors, loose Indoors, crated Indoors, confined to a room or area Outdoors, loose Outdoors, confined to kennel or area

Do you have any dogs now?  Select one: Yes No

If so, please list their breeds, genders and ages: 

What other pets do you currently own? 

What characteristics do you dislike most in dogs?

Will you take this dog to obedience classes?  Select one: Yes No

Why do you want an English Cocker rather than another breed?

If you have had an English Cocker before, from whom did you purchase him/her?

Are you looking for a puppy now?

Select one: Yes, I want to get one now. Yes, I want to get one within a few months. Not now, but I'm finding a good breeder for the future.

Describe your ideal dog's personality -- what traits do you value and want the most?

What gender do you prefer?  Select one: Male Female

Would you consider either gender, if your preference is not available?  Select one: Yes Maybe No

Please indicate what colors you will accept:

Black (solid)
Black and Tan (solid black with tan markings)
Red (solid)
Blue Roan (salt and pepper)
Blue Roan and Tan (salt and pepper with tan markings)
Orange Roan (salt and red pepper)
All are OK -- no preference

Have you ever housebroken a puppy?  Select one: Yes, from scratch Yes, picking up where someone left off No, but I'm ready for the challenge No, and I wish I could hire someone to do it

What is your primary reason for wanting a dog?  Select one: Conformation (show) Obedience (competition) Agility Field or Hunting Pet Other

If you have a veterinarian now, please give his or her contact information:

Name
Clinic/Hospital
Street Address
City
State
Zip
Phone
E-mail

Please tell us anything else we should know about you or your search for an English Cocker.