This Questionnaire is required for all potential owners of our dogs. However, filling out the questionnaire does not mean that you will
automatically qualify to own a puppy. We reserve the right to deny any potential owners that we feel do not meet our criteria.
Please provide us with accurate and detailed answers. Upon completion please or email it to, admin@bellepeyton.com or mail it to
Lisa Marie Wilkins, 7636 Gaither Rd. Sykesville, Md 21784
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Name:___________________________________________________________________________________
First Last
Address:________________________________________________________________________________
Street City State Zip
Phone Number: ___________________________________ ___________________________________
Home Work
Email: ___________________________________________ Fax: ______________________________
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1. Why have you chosen a Kerry Blue Terrier to be a part of your family? What attracted you to the breed?
2. Are you interested in a “show prospect” or “family pet/companion”? Do you prefer a male or a female? Why?
3. The average cost to maintain a healthy pet is $800 per year. Have you prepared yourself for this expenditure?
How?
4. Do you live in an: Apartment _____ Home _____ Condo _____ Duplex _____ Other _____ Does it have a
fenced yard?
5. Do you: Own ________ Rent _______ Landlord's Name: ______________ Phone numbers: ______________
6. Is anyone in your household allergic to dogs?
7. How many adults ____ and children ____live in your household?
8. What other pet(s) do you own or have owned in the past 10 years?
Type _____________________ Age ______ Sex ____ Time Owned _______ Still Own? If not why? ______
Type _____________________ Age ______ Sex ____ Time Owned _______ Still Own? If not why? ______
Type _____________________ Age ______ Sex ____ Time Owned _______ Still Own? If not why? ______
Type _____________________ Age ______ Sex ____ Time Owned _______ Still Own? If not why? ______
7. Who will be responsible for taking care of this puppy?
8. How will you maintain your Kerry? (Check all that apply) crate ____ fenced yard _____ loose in house _____
garage _____ patio _____ basement ______ tethered _____ other_____
9. Will there be someone home during the day to take care of the puppy’s needs? How many hours will the
puppy be alone?
10. What veterinarian facility will you be using? Please provide me with their contact information.
11. A Kerry Blue's average life span is 12 to 15 years of age. Will you be prepared financially to take care of your
dog through it's geriatric stage of life?
12. Kerry Blue Terriers are social dogs and do not adjust well kept outdoors and away from their family. How will
you provide this breed the time and attention it needs to be a well-adjusted pet.
13. Kerries require on average a 20 to 30 minute walk/run at least twice a day, are you able to provide this sort of
exercise? If not, what other means of exercise will you provide?
14. Kerries require a good brushing at least twice a week and a professional grooming job at least every 30 to 60
days. How do you plan to provide proper grooming and coat care?
15. Kerry Blue Terriers make a wonderful addition to your household; however, they do have a willful nature so
basic obedience is recommended especially with novice Kerry owners. How will you provide the proper training
for your new Kerry.
16. How did you find out about us? Just Surfed In ____ Friend____ Dog show_____
Kerry Blue Terrier Club ____ Breeder Listing ____ Specific Web Search____ Other ____ (please specify)
Thank you for your interest in a puppy from Belle-Peyton Kerry Blue Terriers!
Please continue to visit our website at www.bellepeyton.com
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