Mini American Shepherds Killingworth CT
Application
(Please Print & Mail) Mailing Address: Carole B. Pleines 628 Route 148 Killingworth, Ct 06419
carole@miniamershep.com
Ayers Rock Killingworth, Connecticut 475 331 5105
Name: ____________________________________________________________
Address: _________________________________________________________
City: _____________________________________________________________
State & Zip Code: ____________________________________________________
How long have you lived at address: _______________________________________
Phone: Home, Cell, and E-mail:___________________________________________
Best time to call AM or PM: ______________________________________________
Have you ever owned a dog? ______Have you ever owned and raised a puppy? _____
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 puppy? :_____________________________________
How many family members in your home? Ages? :_____________________________
Are there family members with known allergies to dogs? :________________________
Is shedding be a concern? _______Do you have a gender preference? _____________
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)
what vet will 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@miniamershep.com 475 331 5105
The balance is payable in full at the time of puppy selection/allocation at 7 weeks of age,
Or after temperament testing has been completed or at any time after selection is made.