Puppy Questionnaire



If you feel that any additional information would be helpful, please
add it to the bottom of the form.
All information is kept confidential and used only by the
Breeders/Owners of the litter.
We thank you for your cooperation and interest.

(This form may be copied and pasted to an E-mail.)

Please complete the entire form below

First Name

Last Name




Zip Code

Home Phone


Your Occupation

Spouses Occupation

How did you learn about us? Internet Another breeder Other

Why have you decided to purchase a Golden Retriever?

Do you prefer: Male Female No Preference

For what purpose(s) are you purchasing a Golden Retriever?

Do all family members want a new puppy? (yes/no)

Are there children in the Family? (yes/no)
Gender & Ages:

Do any family members have allergies to dogs? (yes/no)

Have any family members ever been bitten by a dog? (yes/no)
If yes, please describe below:

Are any family members afraid of large dogs? (yes/no)
If yes, please describe below:

Do you: Own Rent Lease your principal residence. Do you live
in a: House Townhouse Apartment

Where will the Golden be accommodated during the day: House Crate in
house Dog run with dog house Yard with dog house Other

If other then please describe:

Is someone home during the day, or able to get home to "potty" the
puppy? (Yes/No)

If "no", what kind of arrangements will you be making for your new

Where will the Golden sleep at night?

Do you have a securely fenced yard? (yes/no)

Do you padlock your gates? (yes/no)

Do you have a chain link kennel run? (yes/no)

If yes, what is the size?

Please describe yard size and fencing:

Are there neighborhood restrictions on owning a dog? (yes/no)

Are you committed to care for this dog's needs for his/her lifetime?

Do you have other pets? (yes/no)
If yes, please describe (breed & age)

Are you willing to take this dog to obedience classes so that he will
an enjoyable companion and a good canine citizen? (yes/no)

Have you ever owned a puppy? (yes/no)
If yes, when and what breed?

Who will train this dog?

Have you ever crate trained a puppy or dog? (yes/no)
If no, please describe why:

Have you ever completed an AKC title? (yes/no)
If yes, please list completed titles:

What type of personality are you looking for in your puppy?


Are you willing to spay/neuter this dog? (yes/no)

Please include anything else that will help us place the right puppy
with you:

Please name 2 person (s) that we could contact for references.
Please include one being name of the veterinary clinic who knows you?
List name (s), phone number (s) and email (s)

I understand that sending this application does not automatically
entitle me to a dog.
I understand that this application is just a beginning step in the
interview process.

All of our companion or pet puppies are sold with AKC Limited
Registration and
spay/neuter contracts. This means that the dog is registered with
however none of the offspring are eligible for registration.
A dog with a Limited Registration as well as a spayed or neutered dog
can compete in all AKC events except in the Conformation classes
(breed ring)
Please review and then submit this completed questionnaire. We will
contact you via
Email as soon as possible regarding the availability of our

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