Avonview Kennel Questionnaire Name: Address: Phone: Email: Yes No 1. Are all family members in agreement on getting an English Springer Spaniel?   Number of Adults in the Family Home Number of Children in the Family Home Age of Child 2. Do you have a securely fenced yard? 3. Do you have a pool? a. If so is it fenced in separately? 4. Are you aware of the care requirements of an English Springer Spaniel? 5. Are you aware of the grooming requirements of an English Springer Spaniel? 6. Are you aware of the attention and exercise requirements? a. Are you able to exercise your English Springer Spaniel at minimum of 1 hour each day? 7. Are you aware that an English Springer Spaniel can live up to 16 years? Are you prepared for that? 8. How many hours per day will you be able to spend with your English Springer Spaniel? 9. Do you plain to obedience train your puppy? 10. Will you spayed or neuter your English Springer Spaniel before one year of age? 11. Do you currently own any other pets? Please indicate type and number Dogs Cats Other 12. Do you prefer a male or female?

Avonview Kennel Questionnaire Name: Yes No 13. For what purpose are you buying an English Springer Spaniel? (Check all that Apply) Pet   Show Obedience Field Agility Therapy Other 14. Tell me a little bit about what you are looking for in your English Springer Spaniel? Personality, Energy Level, Color (B/W or L/W), adult or puppy 15. If you have a veterinarian may I contact him/her for a reference? Veterinarian Office Name: Phone: 16. Can you please provide me with one other reference of someone that I can contact? Relationship: Phone or Email: By submitting this form, I verify that I have answered the questions truthfully. I also understand that this information is private an will not be sold or distributed by Avonview Kennels. Signature: Date: If you have any additional questions please don't hesitate to email or call anytime. Owner: Christine Remme Phone: 1-902-472-2719 Email: cremme@eastlink.ca