Name(s)___________________________________________________________
e-mail Address_________________________________________________
Address_________________________________________________
__________________________________________________
City, . . . . . . . . . . . .State, . . . Zip
(_____)___________________________
Phone
Occupation_________________________________________
How long have you lived in the area?____
Do you plan to move in the next 2 years?____
Do all heads of household agree on this purchase and breed of dog.
Number of children in household____________?
Ages of Children?_______
___________
___________
Any other pets in the home?__________
Do you own (__) a house (__), trailer (__), a condo (__)?
or do you rent (__) a house (__), trailer (__), a condo (__), an apartment (__)?
What kind of exercise area do you have, i.e., a fenced yard?________________
What is your plan to provide exercise and training for your Klee Kai.
Have you had a dog before? (___)yes (___)no If yes, what kind of dog and what happened to it.
__________________________________________________________
______________________________________________________________________
________________________________________________________________________

In case of the owner(s) death(s) this Klee Kai will:

1. (___)be kept by a family member whose name, address and phone number are as follows:
Name_______________________
Address__________________________________________________________ City,ST,Zip__________________________________________
Phone number__________________

2. (___)be placed in a new home by a family member as indicated above.

3. (___)be returned to the breeder for placement in a new home.

Wherever this Klee Kai is placed, the Breeder must be informed of the new owner's name, address and phone number.

PERSONAL REFERENCES

Any person reserving or adopting any Klee Kai is required to fill out this personal information.

Name of personal reference_________________________________________
Address_________________________________________________________
______________________________________________________
City, . . . . . . . . . . . . State, . . . . ZIP Code
(___)_______________
. . . . Phone

_______________________________________
Signature(s) of applicant
_____________________
Date

Klee Kai National Kennel Club