Name:

Address:

Phone:

Email:

Number of adults in the family:                 Number of children at home:             Ages:

Other pets (number, species, ages, etc.):

Referred by:

Have you ever owned a dog?             Which breeds?

What happened to your last dog?

If you have ever owned a Golden, from whom did you acquire it?

Do you have experience with the breed?

Why did you decide on a Golden?

Do you live in an apartment, house, townhouse?

If you rent, do you have your landlord's permission to have a dog?

Do you consider your yard large, small, average?

Is your yard fenced?             Type of fencing (Invisible Fence™ is not considered fencing):

Where will you dog spend most of its time?   In the house:      fenced yard:       house with dog door access:     other:

Generally how much time will the dog be alone during the day and night?

Do all adults work outside the home? If so, does one have a flexible schedule to care for the puppy?

In spite of the best care and the best breeding practices, health problems may occur that require surgery or extensive treatment. These problems can include but are not limited to:  OCD, hip dysplasia, liver shunts, allergies, cancer, accidental poisoning, and auto accidents. Can you afford good veterinary care and are you willing to invest in your puppy in the event of  health problems?         

Are you willing to take your dog to obedience classes so that it will become an enjoyable companion and good canine citizen?

Have you taken previous dogs to training/obedience classes?

Are you interested in your dog for (check all that apply):

companion_____hunting_____agility_____conformation_____

therapy dog_____tracking_____show_____ obedience_____hunt tests_____

Are you interested in joining the:

Local Golden Retriever Club?

National Golden Retriever Club?

Preference for sex of puppy?       Male   Female   Either

Reason?

Are you willing to buy and use a crate?

Are you familiar with proper crate use?

Are you willing to abide by a contract that specifies matters regarding registrations, health, breeding, and general care requirements?

Will you agree to spay or neuter the puppy?

If not purchasing a puppy for conformation showing, will you accept a limited registration (does not allow offspring of your pup to be registered or your dog to compete in conformation)?

Until your dog is at least two years old are you willing to keep it thin, on an adult premium dog food, and not expose him to exercise that jeopardizes joint formation?

Are you willing to keep the dog on heartworm preventative and safe flea/tick control products?

Please provide three references (preferably breeders, veterinarians or friends who currently have/had dogs)

Is there any additional information you would like to share?