Beltane Kerry Blue Terriers

Questionnaire for Screening Potential Puppy Buyers
For upcoming or Existing Litters

Thank you for your interest in Beltane Kerry Blue Terriers. This is a questionnaire that will help us become acquainted with prospective owners for one of our puppies. The information you provide will guide us in placing the right puppy in the right home; to ensure the greatest possibility of success for a happy life together. This is not a contract and does not guarantee you a puppy. At Beltane Kerries we interview prospective buyers very carefully to make sure a Beltane puppy will be a good match for you and your family.

Name:__________________________________________________________________________________

Address: ______________________________XXXXXXXXXXXXXXX	Email: ____________________
City/State:_____________________________	Fax Number:________________
Home Phone:___________________________	Work Phone:_________________

Do you currently reside in a house, duplex, apartment or etc? ____________________________________

Do you have a securely fenced yard? YES NO If yes, how high is it? ________________________

If no, how will you restrain your puppy? ____________________________________________________

Please list who lives with you and their ages. _________________________________________________

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If you have children what has been their experience with dogs in the past? __________________________

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Does anyone in your family have severe allergies? Please specify. ________________________________

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What do you know and like about Kerry Blue Terriers and how did you first learn about the breed?

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Have you owned a dog before or is this your first? ______________________________________________

What breeds have you owned and were they male or female? (spayed or neutered?)____________________

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Describe your relationship with the most recently owned dogs and how long they lived with you. ________________________

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___________________________________________________________please use the back for extra space.

Are you interested in a conformation show dog? YES NO

If yes, have you ever shown dogs before? ____________________________________________________________

Do you have any future plans for obedience, agility, performance or therapy work for your dog? __________________________________________

Do you have any plans to breed this dog? YES NO

If yes, why are you interested in breeding? ____________________________________________________

If no, would you be willing to sign a spay/neuter agreement and accept limited registration? _____________

Please list any other pets you have at this time that will be living with your new Kerry puppy. ___________ _______________________________________________________________________________________


Approximately how many hours during the day will the puppy be left alone? _________________________

Where will your Kerry spend the day? ________________________________________________________

Where will your Kerry sleep at night? ________________________________________________________

Do you have a vet you have used in the past or plan to interview one to care for your new puppy? YES NO

Please provide us with the name, address and phone number of the vet you plan to use.

Name: ______________________________XXXXXXXXXXXXXXX	Phone: ____________________
Address:_____________________________	Email:________________
City/State:___________________________

Are you prepared to brush your Kerry nearly every day and either pay someone every 4-6 weeks to groom your Kerry or buy the necessary equipment and learn to groom your Kerry yourself? _________________ ______________________________________________________________________________________ ______________________________________________________________________________________


Are you familiar with and are you prepared to crate train your puppy? _____________________________ ____________________________________________________________________

Do you plan to participate with your puppy in Basic Obedience Classes? YES NO

What type of behavior do you expect of this breed? _____________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________

What is your definition of disciplining a dog? __________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________

How did you find out about us?

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Do you have a preferece for the gender of your puppy?

Male? _________________________

Female? _______________________

No Preference?__________________

Please list three references with their phone # and/or e-mail addresses.

1. ________________________________________________________________________________

2. ________________________________________________________________________________

3. ________________________________________________________________________________

If there is ever a situation where you can't keep your Kerry ( FOR ANY REASON - AT ANY TIME IN THE DOGS LIFE ) would you be willing to contact us and assist in returning him/her back to us? _______ Would you be willing to sign an agreement in regard to this? _________

Thank you for completing our questionnaire. Please return it to us with a (refundable) deposit of $400.00. We will contact you to set a time for a phone interview after reviewing this information. We take our responsibility as breeders very seriously and encourage all new owners to keep in contact with us throughout the life of their dog. We fully guarantee the health and well-being of our puppies. Both pet and show puppies are sold with a contract. We are always available to give advice or just share in the joy a Kerry can bring to your family. Our Kerries are members of our family and we expect a Beltane puppy will be a welcomed member of your family as well. Hours of socialization and human interaction make our puppies outgoing, affectionate and confident. If you have any questions for us, please don't hesitate to ask.


Jana & Michael Deaton
25011 - 650th Ave
Nevada, Iowa 50201
515-382-3246
beltane@kerryblue.net