Contact Information:

State/ Province:
E-mail (REQUIRED):
Day #:
Eve #:
Cell #:
What is the best time to call you at the above numbers?
Years Employed:

Family Information:

Marital Status: Married/single
Name of Spouse/Significant Other:
Children in the home or visit often: Name, Age, & Relationship
Other Adults in the home: Name, Age, & Relationship

Other Pets:

Do you currently have any other pets?
If "yes", please list and describe your pet(s) as follows:
Name, Type, Age, Sex, Spayed/Neutered

Current Veterinarian Information: Name, Address, Phone #

Current Residence Information:

Do you own or rent your home:
Type: Detached single-family home, Townhouse/Duet/Duplex, Apartment/Condominium, Other
How Long At Residence:
Any Plans of Moving?
if yes - please describe
Please describe the approximate size of your
yard and the type of fencing (if applicable):

Canine Accomodations:

Will the dog live primarily inside or outside?
When the dog is outside,
please describe the shelter it will have:

Schedule Information:

Will there be anyone home regularly during the day?
If "yes", approximately how many hours per day?

Past Dog Experience:

Have you ever owned a dog?
Please list breed of dogs, when you owned them
and if you no longer have them, what happened to them?

Cane Corso Related Information:

Please explain why you want a Cane Corso:
What type of canine training experience do you have?
Puppy kindergarten, Obedience training, My dog passed the CGC, My dog passed the TDI, My dog passed the TT, Advanced (SchH, PP, etc.)
Do you have a trainer that you currently use or
have used in the past? (please describe)
What activities will you and your Cane Corso be involved in?
Agility, Conformation, Obedience, Puppy Kindergarten, Schutzhund, Personal Protection, Therapy Work, Tracking, Weight Pulling
What is your timeframe for getting a Cane Corso?
What is your purpose for getting a Cane Corso?
Show, Breed, Work, Protector, Companion

Do you prefer a male or female?
Do you plan to spay/neuter?
How did you learn about Wasatch Mt. Cane Corso?
Do you plan to crop the ears? Yes,No, or Undecided
What kind of temperament are you looking for in a Cane Corso Italiano?
If your goals include Show Champion, Schutzhund, Personal Protection, or any other sport where you can achieve titles, have you ever titled or trained a dog to these titles? If so, please tell us what kind of achievements you have had in the past


Please supply names and telephone numbers of personal
references, preferably individuals who are familiar
with your care of animals:
Please give us any other additional information about
yourself that will help us determine the best Cane Corso
to match you and your family with. Also, you may tell us
if you are interested in a puppy we have available
or one of our upcoming breedings:


Please type your full name here. By doing so, you are giving us your e-signature that the above information is true and correct to the best of your knowledge. Your e-signature also authorizes us to contact any individual listed above and obtain information about you that could be regarded as confidential. This in no way binds us to sell you a dog, nor binds you to buy a dog. This is for informational purposes only.

Dan and Alisha Kierstead
Home: 801-688-1729

Copyright Wasatch Mountain Cane Corsos, 2006.
All Rights Reserved. No part of this web site may be copied, duplicated or linked to from any other site
without the written consent of Wasatch Mountain Cane Corsos.