Request Form

Puppy or Dog Request Form:
Please print off this page, read it thoroughly and mail it to me.  Thank you!  

Mail to:
Pam Martin – River Runs Australian Shepherd Kennel
173 Ream Road,  Winter Haven, FL  31280

NAME:
ADDRESS:
 CITY:  STATE / ZIP:
HOME PHONE:  CELL PHONE:
EMAIL:
Have you or your family ever owned an Aussie before? If no, are you aware of the exercise, grooming and training requirements of this breed?  YES  NO
Do you or your family currently own an Aussie?  YES  NO
What facilities do you have for your new Aussie? KENNEL FENCED YARD OTHER:
Are you prepared to commit to a minimum of basic obedience training under the supervision of a professional?  YES  NO
If you have other dogs, briefly tell us about them (breed, sex, age and whether spayed/neutered)?
If you have children, what are their ages?
If you own a dog or other pet/s, below,  please give the name, address, and phone number of your veterinarian so that we may contact them for a reference.
VET INFORMATION:
Name
Address
City
State/Zip
Phone (          )

Check Preference (please check your 1st and 2nd preference)

COLOR:
RED MERLE BLUE MERLE RED TRI BLACK TRI RED BI BLACK BI NO PREF.

 

SEX  MALE FEMALE NO PREF. EYE COLOR
PREFERENCE
1 BLUE EYE 2 BLUE EYES NO PREF.

 

What areas of interest would you like to pursue with your Aussie? (check all that apply)

WORKING STOCK OBEDIENCE CONFORMATION AGILITY 4-H PROJECT WATCH
DOG
TRICK
DOG
COMPANION
BREEDING OTHER

 

In your own words, what are your plans for this puppy or dog?
List any information you think will be helpful to me in helping to choose the right puppy or dog for you and your family:
Mail to:
Pam Martin – River Runs Australian Shepherd Kennel
563 Ream Road,  Winter Haven, FL  33880
Email: info@military flash light.info

Phone: 863-441-9671
Cell: 863-098-3229