Please fill in the answers and then submit........
Churchill's Min Pins
& Harlequin Pinschers
Puppy Questionnaire
25 QUESTIONS & 3 REFERENCES
Please answer the following questions as completely as you can, and return this form when you've finished. “THANK YOU”
Address ( please include your full address with road, city, state & zip):
1. Do you own or rent your home?
2. If renting is it okay with your landlord?
3. What reference materials have you read about Miniature Pinschers (or Harlequin)?
4. What is the main reason you have chosen a Miniature Pinscher (or Harlequin)?
5. Have you ever owned a Miniature Pinscher (or Harlequin)? 
Or do you know of any one who has ever owned a Miniature Pinscher (or Harlequin)?
6. Are you interested in a male or female?
7. Do you have a color preference? First? 

8. Are you willing to sign a spay/neuter contract? 
If no please explain?
9. Do you have other pet? 
If so are they spayed/neutered?
10. If you have pets what kind are they? 
How old?
11. Do you have children? 
If so what are their ages? (It is okay if you do have
children I have 2, they are great with the pups as long as they are thought
on how to act around the pups)
12. Does everyone in your household agree upon getting a puppy?
13. Where will you be keeping your Miniature Pinscher (or Harlequin) in your home or outside?
14. Have you ever house trained a pup before?
15. Who will be the main care giver for the pup?
16. Do you work? What do you plain on doing with the pup while at work?
17. Do you have a fenced in yard? If yes, what type?
18. Will you be attending any puppy training classes?
19. If you are plaining on training the pup your self have you ever trained a
puppy before?
20. Are you will to give the Miniature Pinscher (or Harlequin) back with all AKC (or HPA) paper work if you are
unable to keep him/her?
21. Have you ever returned a pet to a breeder? 
If so, why?
22. Have you ever given a pet away?
If yes, why?
23. Have you ever taken a pet to the pound? 
If yes, then why?
24. Do you understand the difference between a limited registration and a full registration?
25. Are you willing to keep in touch and let me know how the puppy is doing?
Three references are needed Please list below name & numbers
(please include your vet as one reference)
1.
2.
3.
Please let us know how you heard about us (hoobly, puppyfind, breedersnet,,,,,)
Thank you so much! This is for my piece of mind that I am placing the pup in a good home!!!