**A u s t r a l i a ' s  L e a d i n g  S h i b a  I n u  B r e e d e r**

Questionaire

Puppy Questionaire & Application

Name *
Prefix
First *
Last *
Suffix
Phone *
Email *
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Have you read our Shiba FAQ page? *
 Yes 
 No 
Have you researched the Shiba Inu breed? *
 Yes 
 No 
Why do you want a Shiba? *
Please describe the Shiba Inu characteristics pros and cons *
I want a puppy/dog for..."
 Companion 
 Show 
 Breeding 
 Agility 
 Other 
(Select all that apply)
What age Shiba do you prefer? *
 Puppy  
 Adolescent (6 to 18months) 
 Mature (2+ years) 
Do you have a colour preference? *
 Red 
 Black & Tan 
 Sesame 
 Cream 
 No Preference 
Do you have a sex preference? *
 Male 
 Female 
 No Preference 
Have you ever owned a dog? *
 Yes 
 No 
If Yes, How many dogs do you currently own?
 One 
 Two 
 Three 
 Four 
 Five + 
Do you have any cats or other pets?
 One 
 Two 
 Three 
 Four 
 Five + 
Please describe your current pets (type/breed/gender)
What type of home do you live in? *
 House 
 Townhouse 
 Unit / Apartment 
 Acreage 
 Share House 
Do you have a secure fenced yard? *
 Yes 
 No 
Will your Shiba live indoors or outdoors? *
If you have have no secure yard, how do you intend to keep your Shiba confined and prevent him/her from being stolen, lost, hit by a car or meeting with some other hazard?
Do you plan to move? *
 Yes 
 No 
 In the future 
Do you have any children? *
 Yes 
 No 
 In the future 
If Yes, please describe (age)
Do you work full time? *
 Yes 
 No 
How long will your Shiba be left alone at any one time?
Does everyone in your family/household want a dog? *
 Yes 
 No 
Does anyone in your family/household suffer from allergies? *
 Yes 
 No 
If you are away for an extended period (holiday, work etc.), where will the dog be?
Have you ever had to give up a dog or other pet?
If Yes, Please elaborate
Is there any additional information that you would like us to know about you?
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Contact Details
Debbie & Vanessa Bexton
Brisbane, QLD, Australia
Phone : 0406737222
Email : debbie@orientakennels.com

 

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