Potential Owner Questionnaire

Please take your time and carefully consider the questions, below. We take our obligation as breeders very seriously. As a result, we have adopted this form as an initial screening tool for potential owners.

Your contact information:
Full name:	* required
Email address:	* required
Telephone number:	* required
Address:
City:	* required
State:	* required
Zip Code:
Your Interest in Manchester Terriers:
How did you learn about MT's?:	Owned Previously Attended/Watched a Dog Show Friend/Family Own a Manchester AKC Website/Researched Online Other
Have you owned a dog previously?:	Yes - As an Adult Yes - As a Child No
Toy or Standard?:	Toy - Puppy Toy - Older Dog Standard - Puppy Standard - Older Dog Not Sure
Male or Female?:	Male Female Doesn't Matter Not Sure
Show or Companion?:	Companion Show in Conformation Both Not Sure
Performance?:	Obedience Agility Earthdog Flyball Therapy No Performance Not Sure
Your Household:
# of Adults:	1 2+
# Children <5:	None 1 2 3 4
# Children >5:	None 1 2 3 4
# Dogs:	None 1-2 3+
Fenced Yard:	Yes No Will Install for Dog
Age/Gender/Breed of any dogs currently in your home:
Your Lifestyle:
Time to Attend Training Class:	Yes No Not Sure
Plan for Vet Care?:	Yes No Not Sure
Extensive Travel?:	Yes No Not Sure
Please describe how you plan to exercise a dog (i.e., dog park, walks):
Background:
Have you or any member of your household been....	Convicted or pled "no contest" to Animal Cruelty, Neglect, Abuse, or similar charges including but not limited to being a spectator at dogfights or other illegal blood sports? Yes No Not Sure
	Subject to disciplinary action by the American Kennel Club?: None Yes - Reprimand Yes - Suspension (Event) Yes - Suspension (Registration) Yes - Suspension (All)
	Suspended or had event or registration priviledges revoked by the Government or AKC Recognized dog registry in your country of residency?: Yes No Not Sure
	If you answered "Yes" to any of the preceding three questions, please explain:

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