This quetionnaire is for the mutual benefit of you, the prospective owner, me as the seller/breeder and the Golden Retriever you plan to have as a member of your family.
It does not constitute a contract on my part to provide you with a puppy, nor does it obligate you to take one.
Your answers to the questions are not the only factor in the determination of your suitability as a Golden Retriever owner.

Your Full Name:
Address:
City, State, Zip Code:
E-Mail Address:
Home Phone (Including Area Code):
Cell Phone (Including Area Code):
Best Way and Time to contact you:
Date:

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How were you referred to us:		Internet Search Breed Club or other Breeder Friend
(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 No
Do you own your home, rent or live with others?		Own Rent Live With Others
If you rent, has your landlord agreed in writing to allow you to have a dog on the premises?		Yes No
Is your residence rural, suburban or in the city?		Rural Suburban City
How long have you lived at your present address?
Do you have a securely fenced yard?		Yes No
If Yes, what type of fencing?
Do you have a swimming pool?		Yes No
If yes, is it fenced separately from the yard area?		Yes No
Where will the puppy stay during the day?		Inside Outside
Where will the puppy stay during the night?		Inside Outside
Who will be the primary caregiver?
Does anyone in your family have allergies?		Yes No
If Yes, Please Explain?
Have you ever owned a Golden Retriever before?		Yes No
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 No
If yes, What Breed(s) and what happened to them?
Are there any other pets in residence in your family right now?		Yes No
If yes, What types and what are their Ages?
Do you have a Regular Veterinarian?		Yes No
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 No
If yes, please Explain:
Do you plan on using a crate for your puppy?		Yes No
If not, Why Not?
Which of the following best describes your goals for your puppy?		Pet/Family Companion Conformation Shows Hunting Obedience Agility Pet Therapy Other
If Other please Specify
If requesting a Show/Performance puppy, please briefly summarize your Experience:
Which sex are you primarily interested in?		Male Female Either
Will you accept a puppy of the opposite sex if your first choice is not available?		Yes No
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 No
If not, Why Not?
Are you willing to attend a minimum of one set of obedience classes?		Yes No
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 No

If you do not get a response to your application within 3 days please contact us by e-mail or phone.
We may not have received your application.
Thank You.