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	First name: (Required)	Last name: (Required)

	Street address: (Required)



	Town / City: (Required)	State / Province: (Required)

	Postal / Zip code: (Required)	Country: (Required)

	Email address: (Required)

	Home phone number: (Required)	Mobile phone number:

	Subject: (Required)


	Color and sex of puppy:



Does anyone in your household have allergies to animals? :

Have you ever returned a pet to the breeder, given a pet away, or taken a pet to a shelter? :
	Tell us a bit about your past and current pets:: (Required)

	Do you intend to enter your Cavalier in any kind of dog shows/competition? If so, have you involved any other pets in competition? Do you want to breed your Cavalier?: (Required)

	Where will your Cavalier/Cockalier spend his/her days? Where will your Cavalier/Cockalier spend his/her nights? How much time will he/she spend outside? & How will he/she be confined while outside?: (Required)

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