Thank you for your interest in Portuguese Water Dogs (PWD)...

Thank you for taking the time to complete this questionnaire. Your answers will permit us to more effectively match our puppies' or rescue dogs' needs with your life-style and requirements. A questionnaire MUST be filled out for you to be eligible to acquire one of our PWDs.

Your full, legal name, a valid email address, a valid telephone number, and fields marked with an "*" are MANDATORY for a reply to this form. If you do not have an email address, please submit form indicating "none" in that box. THEN call us at (757) 482-4781.

We REQUIRE the name, address, and telephone number/e-mail address of each Reference.  Forms submitted without this information will be disgarded without response!

If you have any comments or concerns about adopting a PWD please share them with us. We are always interested in talking about PWDs in general and our babies in particular.

*Your full, legal name:

*Your email address: (e.g.: We will reply to your form submittal with this address. A bogus email addresses will result in the deletion of your form.

Please provide an alternative E-Mail address if you have one. This is very valuable if we are unable to contact you using the primary e-mail address!:

*Your home phone number (with country, city, area codes):

Alternative (e.g., cell, work) phone number (with country, city, area codes):

Best Time to call:  

Your Occupation:  

City/Town: State/Prov.:  
Post./Zip Code: :     Country

Do you RENT or OWN? 

If you rent, what is the name and phone number of your landlord?  
Landlord's Name:
Landlord's Phone:

  Do you have a fenced yard? Yes No.  If yes, please describe fence (type, height).  

Does your town or subdivision have any restrictions on the number of pets you can own?



Age:   Relationship Status: Married/Long Term Relationship Widowed Single

If Married or in a long term relationship:
Your Spouse/Significant Other full name:
Your Spouse/Significant Other occupation:

Does your spouse or significant other know and approve of owning a PWD? Yes No

Children?  If yes, what is/are their name(s) and age(s)?

 If yes, how do they interact with animals?

Other pets?  If yes, please give the names and describe type, breed, sex, and age of each:

Are your pets spayed/neutered?  Please specify which one(s).

Please provide your veterinarian's name and phone number:  

If you have had a dog before, describe the last dog you owned and what happened to it?

Why are you interested in owning a PWD?

Have you ever owned a PWD before? If so, what did you enjoy most about it?

Where will the dog stay during the day?  

At night?

Please list 3 references, their relationship to you, their full addresses and phone numbers (including email address(es), if available).  This information serves the dual purpose of assisting in the verification of your form and provides an alternate method of contacting you with important information should your primary contact information change:

*First Reference:

*Second Reference:

*Third Reference:


I am most interested in a:    Male      Female    Either

I prefer a hair type of:         Curly     Wavy      Either

I prefer a coloration of:       Basic Black   Irish    Parti    No Preference

*I am interested showing this puppy for:
        Conformation Championship {Requires Show Contract}
        Obedience/Agility/Water Trials Championship(s) {Requires Pet Contract}
         Both {the whole enchilada} {Requires Show Contract}
         Neither {want a pet only}{Requires Pet Contract}

If you are interested in showing this dog in conformation or obedience/agility:  Please explain.

  I am interested in breeding PWDs {Requires a Show/Breed Contract}  

Please explain why you want to be a PWD breeder.

I am interested in (Check all that apply!):
a young puppy only,  an older puppy (4 Months to 1 Year) would be okay, 
an older dog/retired champion,    a rescue dog.

What are the personality characteristics you find most appealing about a PWDs? (Check as many as apply!)

Active Gentle A one person pet
Affectionate Happy Passive
Aggressive Hardheaded Playful
Attentive Hyperactive Protective
Calm Independent Quiet
Confident Intelligent Reserved
Demanding Loyal Shy
Dominant Loving Sensitive
Easygoing Mannerly Sociable
Friendly Obedient Submissive

Other characteristic(s) you desire: Please describe!

Do you have any concerns or questions about the breed?

Are you willing to accept a dog with special medical needs?

Are you willing to take a dog with a history of neglect/abuse that needs special attention?

How long are you willing to wait for a PWD? (remember, a litter takes 5 months from conception to 10 weeks old)

6 Months     9 Months       More than 9 months

Often, people place themselves on a number of Breeders' Lists.  This is perfectly all right, in fact, we recommend you consider placing yourself on several lists to enhance your chances of receiving a puppy, but, if you get a puppy from another breeder, we would appreciate a notification so we can remove you from our list.

*Yes, I am aware that {short description of image} Portuguese Water Dogs reserves the right to refuse to provide a puppy to ANY applicant for ANY reason.  

Where did you hear about {short description of image} Portuguese Water Dogs?
 A Friend    Web Search    Breeders List    Other Source, please explain in comments.

Comments (put anything else you want to tell us here)?  

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