Your name    

Street address    

City     State/Province     Zip/Postal Code         

Your e-mail        Telephone - Home 

How many members in your household?    

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 you are looking for in your dog, what type of personality, etc ?

Are you interested in a ... Male    Female    Either

Will you agree to sign a spay/neuter contract?   Yes   No

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

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

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 do 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

 Please enter the following password and select "submit"  




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