Your Name:

Street Address:


State / Province:

Zip / Postal Code:

Your email address:

Home Telephone Number:

How many members in your family?

If children, please state ages:

Whose responsibility will it be to feed, walk, train, and socialize your puppy?

Will someone be home with the puppy during the day?

Yes No

Do you live in a...

House Condo Apartment Other

Please Describe:

Do you have a fenced yard?

Yes No

Have you owned a dog before?

Yes No

If yes, what breed(s)?

What has been your experience with crate training?

Please tell us why you chose a Shikoku to share your life:

What are your plans for this pup?

Do you have any thought of breeding in the future?

Yes No

Are you interested in showing/obedience/agility?

Yes No

Please describe the qualities that your are looking for in your dog, what type of personality, etc?

Are you interested in a...

Male Female Either

Would you agree to a spay/neuter contract??

Yes No

Please feel free to add any other comments that would help us get to know you better:

How did you hear about Shikoku Canada? ...or who referred you?

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Shikokus are a breed that is not meant for everyone.

Please be sure to read the information on our ABOUT THE BREED page.

If you eventually purchase a Shikoku, you owe it to yourself, your family and the breed to research the background on your future puppy.

Do not be afraid to ask about the health of the sire and dam of the puppy. Do not be afraid to ask to see health certifications such as OFA clearances and ACVO (American College of Veterinary Opthomologists) or CERF eye exams.

Do ask what the health guarantee is on the puppy you may purchase. Most breeders offer a comprehensive health guarantee.

Know the facts before you purchase a companion that will be a part of your family for 10 to 14 years.

Please feel free to contact Shikoku Canada for any further information.

If you are still interested, please submit this form.

Again, Thank You for your interest in the Shikoku