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PERSONAL: 1. Full Name: 2. Spouse's Name: 3. Your DOB: 4. Spouse's DOB: 5. Permanent Address: 6. County: 7.
Indicate type of residence you live in: a) Townhouse b) Apartment c) Single Home d) Duplex e) Farm f) Other (Please specify): 8. What size yard comes with the above home? a) small b) medium c) large d) acreage 9. What kind of fencing is around the above yard? a)
chain link b) privacy c) no fence (where will the Chacy Ranior be able to play and exercise?) d) other (please specify): 10. In case I need to reach you with news of your puppy: Ø Home Phone: Ø Work Phone: Ø Cell Phone: Ø
E-mail: 11. Airport where your new puppy will be flown to, 1st and 2nd choices
please: 12. A. Are
both partners in agreement about getting a Chacy Ranior? B. Is there anyone in the household who has any doubts or really does not want to get
a Chacy Ranior as a companion for the family? C. What concerns have they voiced? 13. A. In the event that any relationship you are in is dissolved, or
in the event that there is a death in the family, is there a plan for what will happen with the Chacy Ranior? B. Do you understand
our lifetime take-back policy, which states that none of our Chacy Bears should ever be abandoned, given to an animal shelter,
or put out onto the streets? All Chacy Ranior puppies/dogs should be returned to the breeder. 14. Does you or your spouse have any health issues? If yes, please specify: 15. Do you have any children who live
in the home? If yes: Ø How many? Ø What genders? Ø
How old are they? Ø
Do any of them have any fears about dogs/animals?
If yes, how do you plan to deal with that? 16. Are there any children in the home who have any health issues? If yes, please specify: 17. Do both you and your spouse work? If yes, please give an answer
for each of you separately: Ø What are your work hours? Ø
What are your spouse's work hours? Ø What is the nature of your work? Ø What is the nature of your spouse's work? 18. A. What time of year would you like to get a puppy, and why? B.
Do you prefer an adult? C. What is your gender preference? 19. Who will care for your puppy while you are at work or on vacation? 20. If you are gone all day, where will the puppy be physically? 21. What is the total income of the person(s)
who will be responsible for any bills that will occur due to having a dog in the home, please select A,B,C,D,or E? a) 0-25,000 b) 25-50,000 c) 50-75,000 d) 75-100,000 e) >
100,000 22. Do you have other pets already? If yes, what kind, and please explain each pet's personality/temperament. 23. Can you afford to pay the full price
of a Chacy Ranior ($3000)? If not, how much can you afford to pay, please be specific? (Only families who have children with disabilities or major medical issues are
eligible for a discount. Please keep in mind that all puppies being shipped will cost an additional $250 for shipping. Families
adopting discounted puppies or adult Chacy Raniors will also be responsible for the shipping cost, but the cost of the Chacy
Ranior will be negotiated.) EXPERIENCE
and CARE: 1.
Have you ever owned a dog before? If yes … Ø What breed or cross? Ø
How old were you? Ø
Were you the primary care giver? Ø If you do not still have it, what happened that you no longer have this dog? Ø
If you passed this dog on to another person,
who did you pass it on to and why? 2. Do you feel you are able to control a dog with a dominant personality? Ø Why or why not? Ø If yes, how? 3. How much time are you willing to spend grooming your dog? a) daily b) every
other day c) weekly d) monthly e) less than a month 4. Do you plan to do your own grooming, to include nail care, ear care and dental care or do
you plan to have any or all of these done professionally? (If any professionally, which ones?) If you are unable to do this,
is there a friend or family member to help you? 5. Do you have any previous experience in grooming a dog? 6. Do you have any previous experience in canine ear care? 7. Do you have any previous experience
in canine dental care? 8.
Do you have any previous experience in canine nail care? 9. Can you pick up some dog care books to help prepare you for your puppy? Owning a Chacy Ranior 1. How much time do you want to spend
exercising your Chacy Ranior? a) jogging companion b) daily romp, running free c) daily walk d) walk 1-3 days/week e) little exercise time 2. Are you planning to do any specialized training? If yes, what would
be your goals for your Chacy Ranior? 3. Do you want to breed your Chacy Ranior? 4. Are you willing to your Chacy Ranior spayed/neutered? 5. Why did you decide the to add the Chacy Ranior to your family? You may already be aware, but just as a reminder, bringing a canine companion, be it a dog or puppy, into the home
can be much like bringing an infant into the home. It can seem like your pocket suddenly has a hole in it, and bills you hadn't
thought about, may begin to appear: food, vet, shampoos and conditioners, toys, bedding, leashes and collars, flea & tick
control, heartworm preventative, grooming, and the list will go on! Additionally, bringing a new pet into the home can also add additional stresses, such as taking the puppy for walks,
letting the puppy in and out, training the puppy to your desire, and maintaining a food & potty schedule. These will
all require hard work and dedication, and lots of time. Please answer all questions truthfully so we can help choose the best puppy for your family. Use this area to add
anything else you think would be helpful in helping placing the proper puppy for your family.
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