Puppy's Gender:           ________ Male          _______ Female      ________ No Preference
Puppy's Color:     _________ Brown      _______ Deadgrass      _______ Sedge       _______ No Preference
(** Please Note: although we do not guarantee puppy color, we will take this into consideration when selecting your pup. We feel
that          color does not make the dog ! )
Puppy Type:
______ Companion/pet       _______ Companion Hunting       _______ Conformation Showing
______  Obedience             _______ Agility                             _______ Hunt Tests
______ Breeding Prospect _______ Other (please specify) _________________________________
Puppy's Energy Level:       ______ Moderate            ____________ Active
Neuter/Spay :      _______ Will not Neuter/Spay            _________ Will Neuter/Spay
Mallardsway Reg'd Chesapeake Bay Retrievers
Multi purpose companion dogs


Sharol Vandecasteyen                                                                               
23402 Twp.Rd. 492
Leduc County,Ab. T4X 1X5                                                                        
www.mallardsway.com                                            

Please complete this questionnaire so that we can more easily select the right puppy for you. Also indicate which
litter you are interested in
           
                     
                                             Abby 2017  ____________       
Your Name: ______________________________________________________________________

Address:   ________________________________________________________________________

City: __________________________  Province: _____________  Postal Code:  _______________

Home Ph # (        )  _________________  or  Cell Ph. # (         ) _____________________________

email:  ___________________________________________________________________________

Your Signature:  __________________________________________  Date: ___________________
Sharol Vandecasteyen             Leduc County, AB. T4X 1X5          780-986-5640           sharol@xplornet.com
Other Pets:
Number of other pets:    _______   type ______________________    Ages:  _________________________

  Male/Female ________________ Neutered/Spayed _________________________

Special problems or concerns: ______________________________________________________________
Household Members:

Number of adults:  ______     Number of children and ages:  ______________________________________

Hobbies/Activities : ___________________________________________________________________

Allergies(or other health related issues): __________________________________________________
Puppy's Home (please specify where pup will spend most of its time indicating #1,2, 3 etc.)

_______Indoors                                      _______ Outdoor Kennel Run
_______ Outdoor Fenced Yard                _______ Outdoor Farm/Acreage
Puppy Application/Questionnaire