Your phone number (with country, city, area codes):
|City/Town:||State/Prov.: Post./Zip Code:|
Do you own or rent your home? Own Rent
Type of dwelling: House Condo Apartment/Suite Mobile Home
Urban Suburban Rural
Number of adults in your household?
Age? 18-30 30-65 65+
Number and ages of children in your household?
Does anyone in your family have allergies to dogs? No Yes Don't know
Is everyone in your family committed to getting a Nova Scotia Duck Tolling Retriever? No Yes
If no, please explain?
Who will be the primary care giver?
Have you ever met a Nova Scotia Duck Tolling Retriever in person? Yes No
If yes, who's Toller(s) was it?