Puppy Application


Street Address


State                                                          Zip

Day time phone:

Evening phone:

Email address:

Your occupation:

Your spouses occupation:


Please describe the type of housing situation you are presently living in:


If both of you work how will you take care of the puppy during the day?


If you travel what will you do with your dog?


Where will the dog be kept at night?


Ages and number of both adults and children at home?


Do you have other pets?


Please list type and age:


Have you ever owned a Clumber Spaniel before and if so what happened to him or her?



Please list any specific requirements or what you are looking for in your next dog:



Do you have a fenced yard?


Please list two personal references and one vet reference:


Name :



Relationship :



Name :


Phone :




Vet Reference: