Site Meter

Reilly's Yorkshire Terrier & Shih Tzu Application Form

Full Name
Your Email Address
Phone Number
Cell or Pager Number
City, Province
Postal Code/Zip
Where will puppy be kept during the night?
Where will puppy be kept during the day?
Who is the primary care giver?
How much time will puppy spend alone during the day?
Have you owned a dog before?
Do you have any other pets?
If so what are they?
Are you looking for pet or show/breeding quality?
Do you prefer a male or a female?
Why do you want a Yorkshire Terrier?
Have you researched the breed?
Please provide a vet reference
with phone/address and
nsure they have permission to speak to us.

Please provide 2 personal references with name, phone number.
Do you have children? Ages?
How did you hear about us?
Have you ever housetrained a dog before?
Will puppy be attending training classes?
How long did your last pet live?
Have you ever returned a dog before and why?
Do you understand the difference
between a Limited Registration
(Pet only, must be spayed or neutered) and
Full Registration (shown and bred)?

Have you ever given a dog away or taken a dog to a shelter, and why?
Do you intend to breed this dog?
Do you have any questions or comments you would like to add?
Image Verification
Please enter the text from the image:
[ Refresh Image ] [ What's This? ]