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                                                                               
Gen. Del., Rollyview, AB. T0C 2K0                                                                         
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 2012  _______________             ____________
Your Name: ______________________________________________________________________

Address:   ________________________________________________________________________

City: __________________________  Province: _____________  Postal Code:  _______________

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

email:  ___________________________________________________________________________

Your Signature:  __________________________________________  Date: ___________________
Sharol Vandecasteyen            Gen. Del., Rollyview, AB. T0C 2K0            780-986-5640            mallardsway@telusplanet.net
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:  ______________________________________

Special Considerations : ___________________________________________________________________

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
Reservation/Questionnaire