Portuguese Water Dog Puppy Request Questionnaire Please complete and return the following questionnaire. This will assist us in the selection of an appropriate puppy for you and your famiIy. Contact InformationName(Required) First Last Email(Required) PhoneAddress(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Household InformationHow many people are in your household?(Required)Please enter a number from 1 to 10.Do you have children?(Required) Yes No If yes, what are their ages? (separate each age with comma)Does every family member want a dog?(Required) Yes No If not; please explainWho will be responsible for caring for the dog and what is their general home/work schedule?(Required)What made you decide to get a dog, and particularly, a Portuguese Water Dog?(Required)What activities do you participate in for pleasure?(Required)For what purpose are you purchasing a Portuqaese Water Dog? (Check all that apply to you)(Required) Family Pet Obedience Training Show/Breeding Therapy Dog Agility Water Work Other Other, please explain:Do you have experience in raising and training a puppy?(Required)CAPTCHA