Puppy Application Form

XIOMA DOGS

Breeders of Chinese Crested and Perro Sin Pelo Del Peru
Thank you for taking the time to fill our our questionnaire, this will help us determine if a Peruvian or a Crested from us is the right dog for you.

Regards

Sally and Sylvia Johnson

0413-992-645
Xiomakennels.com
Puppy / Adult Enquiry:
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
How did you hear about us? *
How old are you *

Under 18 18-30 30-50 50-60 60 +
Please select the Breed of dog you are enquiring about *
What size of Peruvian are you enquiring about *
Have you owned a Crested or Peruvian before *

Yes Crested Yes Peruvian Other dogs No Dogs
Gender and Coat Choice *

Male Crested Female Crested Hairless Powderpuff Male Peruvian Female Peruvian Hairless Coated
Are you happy to wait for the right dog/puppy? *

Yes No
Are you aware of the personalities of Cresteds *

Yes No
Are you aware of the temperament and requirements of the Peruvian *

Yes No
Do you have other Dogs/Pets in the Home? *

Yes No Cat Dog Other
What are your plans for the dog *

Pet only Pet/Obedience Showing Showing and Breeding Breeding ony
Are there any children under 12 in the house or who will have access to the puppy *

No Yes 1-2 3-5
Where will the dog live? *

Inside Outside kennel
Is you home fully fenced and secure? *
Completing this application is a step in the process to aquiring a puppy from us, but does not guarantee you will get a puppy. The breeder reserves the right to refuse placement at any time or delay until a suitable litter is born.

They are up to date on vaccinations and worming and are micrchipped and health checked by the vet. Parents and sometimes puppies are DNA tested for any health issues in the breed.
You will get a copy of the DNA reports, Vaccination Certificates, Michrochip, Pedigree and Health reports from the Vet.
It is a condition of sale that if you can no longer keep the dog that it is returned to me and not surrendered to a third party. We will take a dog back at any age for any reason. We will not refund if this is the case.
Signature *

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XIOMA DOGS

Puppy / Adult Enquiry: