KPPK Questionnaire Form for a Pembroke Welsh Corgi – Kocher’s Precious Puppies Kennels

Required *

Please Fill Out In ENGLISH Format Only, Any Other Language Formats Will Be REJECTED. If it does not apply to you please put a "N/A", nothing is allowed to be left as empty/blank. If not 100% completely filled out, this questionnaire will be REJECTED.

Are you a Breeder?:

YES NO

Pick One

Are You 18yo Or Older?:

Yes No

Pick One

Are you looking for:

Full Registration - Which is Breeding/Showing Rights Limited - Which is Pet, No Breeding/Showing Rights.

Pick One

Title:

(Pick One)

Name:

First & Last)

Phone # 1:

(###)###-####

Phone # 2:

(###)###-####

Phone Type:

(Pick One)

Phone Type:

(Pick One)

Email:

youremail@email.com

Do you live in a:

(Pick One)

Have you ever owned a corgi before?:

Yes No

Do you have any other pets?:

Yes No

Are you aware of the grooming care required of this double coated dog breed?:

Yes No

** DO NOT shave your corgis in ANY weather. Do Not Clip, Shave, or Cut the coat unless it's a medical reason by your vet, Not Your Groomer. They are not dogs to be SHAVED. **

Do you know that Pembroke Welsh Corgi is a herding dog and they require daily exercise and interactions with humans and other dogs?:

Yes No

What kind of environment would a corgi puppy be a part of?:

Will you continue to crate your puppy at night?:

Yes No

How long would a puppy be left alone when you are at work or school?:

HRS/MIN/SEC

Do you have children in your home?:

Yes No

This is letting you know this is a Recommended Spayed & Neutered Contract at new Owner's expense only never the breeders.

Have you considered, after your puppy has received ALL puppy vaccinations, to go to obedience school with your puppy?:

Yes No

VACCINATIONS & HEALTH FACTS

** For locking in Prices please see "Waiting List Terms And Conditions" Page.

1st Preference

2nd Preference

1st Pick:

Male Female

Pick One

2nd Pick:

Male Female

Pick One

1st Pick:

Red Tri No Preference

(Pick One)

2nd Pick:

Red Tri No Preference

(Pick One)

*Please List Three (3) References:

Reference #1:

Name, Phone #, & Relationship

Reference #2:

Name, Phone #, & Relationship

Reference #3:

Name, Phone #, & Relationship

Would you like to be added to our Paid Waiting List?:

Yes No

To Join is $100.00 Plus a $5.00 to process the payment, it will be deducted off the final payment of the puppy.

How did you hear about Kocher's Precious Puppies Kennels?:

(Pick One)

Do you have any questions or concerns that I may answer for you?

** I do not have a set price, prices are determined by market and shipping. Prices are not stated on my KPPK Website or my KPPK Facebook Page. It's all done thru PM and again no prices is quoted unless puppies are already born. All prices are subject to change whether the transportation goes up or the market goes up, it's at the breeder's discretion.

Electronic Signature & Agreement:

By checking “YES”, you AGREE that all information provided above is correct and true to your word/knowledge. Any FALSE information may result in denial of purchasing a puppy from us. Also by clicking

Yes

"Waiting List Terms And Conditions".

Electronic Signature:

First, M, Last.

Today's Date: