Full Name
*
Phone
*
Email
*
Address
*
City
*
State
*
How Did You Hear About Us?
*
Internet ads
Social media
Customer review sites
Referral
Colleague
What Sex Are You Interested In?
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Male
Female
Any
When would you like to add a puppy to your family?
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T
Please select each of your answers for the following questions below:
For what purpose(s) are you interested in a Golden Retriever?
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Family Pet
Therapy Obedience
Agility/ Conformation
Field Events
Hunting
Breeding
All of our puppies are sold on Non-Breeding Contract and spay/neuter contract. Do you agree to sign and abide to this contract?
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Yes
No
If No, why? (Please state your reason)
Have you spoken with any other Golden Retriever breeders?
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Yes
No
Do you have any interest in getting your dog certified for therapy?
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Yes
No
Are you currently on the waiting list for any other litters?
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Yes
No
Do you have children under the age of 10?
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Yes
No
Are your children scared around dogs and other animals?
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Yes
No
Do you rent or own your residence?
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Own
Rent
Do you have a fenced yard?
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Yes
No
If not, how will you provide security for your puppy when its outside or when you're away?
Is there someone home during the day, or able to get home to "potty" a puppy?
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Yes
No
If no, how long would this puppy be left alone?
Where will this puppy spend the day?
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Will this puppy have regular contact with its family during the day?
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Yes
No
Will this puppy have regular contact with its family during the evening?
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Yes
No
Where will this puppy spend the evening?
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Where will this puppy sleep?
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Are you willing to attend "group" training classes with this dog? (We think classes can provide the needed distraction)
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Yes
No
Are you willing to attend training classes every year with your new pup/dog for the next two or three years?
Yes
No
Have you ever owned a Golden before?
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Yes
No
Do you still own the dog(s) mentioned above?
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Yes
No
If not, what happened to the dog(s)?
If any of the dogs owned are deceased, what were the circumstances?
Do all family members agree on the addition of a Golden to the family?
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Yes
No
Who will have primary responsibility for the care of this puppy?
*
Have you ever given up a dog to a shelter or pound? If so, why? (Our pups/dogs must be returned to us.)
*
If you have previously owned a dog, please give us the name, address, and phone number of your vet (or one that has worked with you in the past):
What type of personality are you looking for in your dog?
Please give us any other information (size, color, etc...) that you think would help us get to know you and what your needs are with respect to placing a puppy most suited to your family and lifestyle.
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Thank you,
SHAYLA TEIXEIRA
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