Part I - Family Information

Name of prospective owner(s):

Address:

Home Phone:

Work Phone:

Employed by:

# Years with current employer:

E-mail address:

Part II - Residence Information

What type of residence do you live in? (check one)

q      Single family house

q      Mobile home

q      Duplex

q      Condominium

q      Apartment

q      Other

Do you own or rent this residence? (check one)

q      Own

q      Rent

How many people live in this residence?

Please fill in the following information for each person (including yourself)

Name

Relationship

Adult/Child

(circle one)

Age

(Children only)

     Adult        Child

     Adult        Child

     Adult        Child

     Adult        Child

     Adult        Child

     Adult        Child

Please tell me about your yard and any fencing around it:

Part III – Contract Information

Do you understand that the agreement you will sign to bring a Hurricane Chinook into your family is a legal and binding contract?

q      Yes

q      No

Have you ever entered into a contract with a breeder before?

q      Yes

q      No

Do you have any questions about entering into a contract?

q      Yes

q      No

Are you willing to co-own a Chinook with the breeder until the entire contract is fulfilled?

q      Yes

q      No

If you get a pet quality Chinook, are you willing to spay or neuter it by 6 month of age?

q      Yes

q      No

Do you agree to take precautions to ensure your Chinook does not get bred accidentally?

q      Yes

q      No

   If so, what plans do you have to ensure this?

If you get a breeding potential Chinook and the breeder determines it is not in the best interest of the Chinook breed to have it bred, are you willing to spay or neuter your Chinook?  At or before the Chinook reaches breeding age (2 years old) the breeder will consider conformation, health, temperament and other essential characteristics of the Chinook.

q      Yes

q      No

If you get a breeding potential Chinook, would you like to be involved in a working group that will help you learn about breeding Chinooks?

q      Yes

q      No

Part IV – Pet Information

Please describe any other pets you currently have in your home:

Have you ever had to give up a pet for any reason?

q      Yes

q      No

   If yes, please explain which pet you gave up, why and what you did with this pet:

Have you ever had to have a pet put to sleep?

q      Yes

q      No

   If yes, briefly explain the circumstances:

Have you ever owned a Chinook before?

q      Yes

q      No

   If yes, tell me about that Chinook:

Why do you want a Chinook?

What purpose will this Chinook serve in your life?

What personality traits are you looking for in a Chinook?

Have you personally gone to visit Chinook owners and their Chinooks?

q      Yes

q      No

  If yes, who? (please list their name, phone number or other contact information)

   If no, would you be willing to go visit a current Chinook owner for an

   interview?

q      Yes

q      No

Are you interested in a male or female Chinook?

q      M

q      F

q      Either

   If you have a specific preference, why?

Are you interested in a breeding potential, showing potential or pet quality Chinook?

q      Breeding Potential

q      Showing Potential

q      Pet Quality

   Why do you have that preference?

Have you ever raised a puppy before

q      Yes

q      No

If you have difficulty with your Chinook puppy, will you be willing to contact the breeder?

q      Yes

q      No

What kind of pet problems have you dealt with in the past?

What kind of pet problems are you not willing to deal with?

Are you willing to take your Chinook to a training class before he/she is 6 months old?

q      Yes

q      No

Have you contacted a local obedience club about puppy training?

q      Yes

q      No

   If so, when will you most likely be beginning class?

Do you already have a veterinarian lined up to care for your Chinook?

q      Yes

q      No

   Who? (name and phone number)

Are you willing to: 1) obtain CERF (eye) exams on your Chinook each year, 2) file those reports with CERF and 3) release a copy to the breeder?

q      Yes

q      No

   This could cost as much as $40 a year.  However, local AKC clubs often hold CERF clinics

   which could lower the cost to as little as $20.  A CERF exam is non-invasive.  It consists of

   dilating the Chinook’s eyes followed by an ophthalmologist looking into the eyes to inspect for

   abnormalities.

Are you willing to have OFA hip x-rays taken when the Chinook reaches 2 years of age?

q      Yes

q      No

   There is some risk to this procedure depending upon how the x-ray is taken.  If your

   veterinarian must use anesthesia, it is possible that your Chinook could react to the anesthesia. 

   However, to my knowledge, there has never been a problem with a Chinook.  After the x-ray is

   taken, the x-ray is sent for evaluation to OFA.  The x-ray itself could cost from $50 to $100, and

   the fee for evaluation is around $20 at present.  Chinooks should never be bred if there is a

   possibility of passing on hip dysplasia.  This condition is very painful in some cases.  Presently,

   an OFA evaluation appears to be a valuable tool.

If you get a showing or breeding potential Chinook, are you willing to breed the Chinook if the breeder or COA determines it is in the best interest of the Chinook breed to have your dog bred?

q      Yes

q      No

If your Chinook is determined to be breedable and you breed your Chinook, are you willing to DNA test your puppies for identification and health tracking purposes before they go to their new owners?

q      Yes

q      No

   DNA sampling is simple, non-invasive and can be done by the owner.  You take a medical

   swab (supplied with the UKC DNA test kit) and rotate it against the inside of the Chinook’s

   cheek.  This collects loose cells onto the swab.  The UKC DNA test kit and the laboratory test

   for each sample costs $59 at present.

Are you willing to maintain membership with the Chinook Owners Association, Inc. (COA), to help support the UKC Chinook, for the entire time you own this Chinook?  Membership cost is between $25 and $35 per year at present.

q      Yes

q      No

Are you presently a COA member?

q      Yes

q      No

Are you willing to get full preventative medical care for your Chinook and keep all his/her shots up to date?

q      Yes

q      No

   The following is an approximation of the immunizations, preventative medicines and check-

   ups your new puppy may need.  You should consult your veterinarian about these

   preventative measures and follow their guidance.

8 weeks

Veterinarian check immediately upon arrival

10 weeks

DHLPP

12 weeks

DHLPP

De-worm

Start heart worm preventative

14 weeks

DHLPP

17 weeks

DHLPP

De-worm

20 weeks

DHLPP

6 months

Rabies

Monthly

Heart worm preventative

Yearly

DHLPP

Rabies

Your Hurricane Chinook puppy comes with:

·       All shots current

·       Worming current

·       A National Dog Registry identification tattoo

·       A health record

·       UKC DNA-VIP identification *

·       50% rebate on any existing COA membership - please tell me you are a member when you pick up your puppy

·       Current health check

* - The UKC DNA-VIP Paw Print identification may be pending at the time the puppies are placed

Part V – Lineage Information

I am just starting to develop a resource site on the Web for potential Hurricane Chinook owners.  Please visit:  http://www.chinookdogs.com for additional information on Hurricane Chinooks.  In addition, specific information for potential puppy owners will be posted at:  http://www.chinookdogs.com/newhome.htm.

Part VI – Other Applicant Information

Please use this space for any other information you want to add.