_{Your full name:}

_{Your email address: (e.g.: you@aol.com)}

_{Details of your family's residence:
City/house
City/apartment}
Country/house
Country/apartment
Condo
Other, please describe in the GENERAL COMMENTS box

Do you have any objections to spaying or neutering your new puppy by 5-6 months of age?
No objection. I agree with sterilization of pets
Yes I object. I want my dog to remain whole
OK after one litter

If you don't currently have any children, are you planning to start a family in the future?
Yes
No
Our children are grown and left the nest

Have you ever had to put a dog to sleep (i.e., euthanasia)?
Yes
No

Have you ever had to take an animal to a shelter or pound? If yes, provide details.

Do you currently have a veterinarian? If so, please provide his/her name.

Have you researched the Akita breed and feel its characteristics suit you and your families lifestyle?
Yes
No
Undecided

My perception of Akitas is that they ...
Shed
Bark when bored
Dig a lot
Are angelic entities that engage in none of the above!
Are great and social
Are territorial guard dogs
Need little supervision

I am familiar with and am willing to use a dog kennel (crate), wire or moulded plastic, to aid in housebreaking and training my dog - as well as to provide him with his own 'den'.
Yes
No
I will research this

In terms of grooming, I think Akitas require: (check all that apply)
daily brushing
weekly combing/brushing
full bath/blow dry every 6 months
Groomer twice a year
I don't know

Do other members of the family want to get a puppy?
Yes, all
Most
N/A - I live alone

What are your plans for your hoped-for new addition? Check all that apply.
Personal companion
Show dog
Breeding
Maybe breeding
Agilty/Flyball/Obedience competitions
Dog for the kids

Would you be willing to take your dog to obedience classes, and to train him/her to be a good canine citizen?
Yes
No
No classes in my area

Why have you decided to get an Akita?

Are you seeking a:
Akita puppy
Akita adult
undecided

Do you have a pool, if so is it fenced?
No pool
Pool - fenced
Pool - unfenced

Are you primarily seeking:
Outdoor dog
House dog

Do you have a securely fenced yard that will contain a moderately large dog?
Yes
No
Planning to erect one soon

How will you safely contain a dog? Please check all that apply.
Kennel run (existing)
Kennel run (will build)
Fenced yard
Tether/chain/rope
Housedog - out on Leash only
No restraint - my dog can run loose

Your complete address: street, city/town, Province/State, Postal/Zip code

Phone number (include area code please)

Were you referred to Prodigal Akitas by some source? Please state how you found us.