How were you referred to us: Internet Search
Breed Club or other Breeder
(if breeder or friend, please provide name)
How many members in your Family and what are their ages?
What are their Occupations/Work Hours?
Is someone available during the day to feed and exercise a puppy? Yes
Do you own your home, rent or live with others? Own
Live With Others
If you rent, has your landlord agreed in writing to allow you to have a dog on the premises? Yes
Is your residence rural, suburban or in the city? Rural
How long have you lived at your present address?
Do you have a securely fenced yard? Yes
If Yes, what type of fencing?
Do you have a swimming pool? Yes
If yes, is it fenced separately from the yard area? Yes
Where will the puppy stay during the day? Inside
Where will the puppy stay during the night? Inside
Who will be the primary caregiver?
Does anyone in your family have allergies? Yes
If Yes, Please Explain?
Have you ever owned a Golden Retriever before? Yes
If Yes, When and How Long?
Who did you obtain it from?
What happened to it? If deceased, how did it die?
Have you ever owned any other breeds of dog? Yes
If yes, What Breed(s) and what happened to them?
Are there any other pets in residence in your family right now? Yes
If yes, What types and what are their Ages?
Do you have a Regular Veterinarian? Yes
If yes, please list the Vet's Name, address, and phone:
Are there likely to be any major changes in your lifestyle in the near future? (i.e. moving, pregnancy, care of elderly relative) Yes
If yes, please Explain:
Do you plan on using a crate for your puppy? Yes
If not, Why Not?
Which of the following best describes your goals for your puppy? Pet/Family Companion
If Other please Specify
If requesting a Show/Performance puppy, please briefly summarize your Experience:
Which sex are you primarily interested in? Male
Will you accept a puppy of the opposite sex if your first choice is not available? Yes
What Characteristics are you looking for in a Golden? (i.e. size, color, activity level)
Are you prepared to have a pet/companion Golden Retriever spayed/neutered? Yes
If not, Why Not?
Are you willing to attend a minimum of one set of obedience classes? Yes
Are you willing to return the dog to the breeder should some unforeseen circumstance arise and you would no longer be able to keep the dog? Yes