DATE :

Please provide the following contact information:

Please list every person who currently resides at your residence. Name , Age, Relation To You

Does anyone in your household have any known allergies to animals?

 Yes No  

How long are you willing to wait for a Golden?

Please check any and all preferences.

light gold     med gold       dark gold      No preference

Please check any and all preferences.

Male           Female         No preference  

Preferred activity level?:

Submissive/Quiet        Weekend Warrior         Active/Outgoing         Rip Roaring           

Will the dog mainly be an...

Outdoor Dog Indoor Dog

Will the dog be expected to participate in any of the following?

Conformation Show                Obedience Trials                 Hunt Tests                       Horseback Riding               
Hunting Companion                Family Pet                       Camping/Boating/Hiking           Guard Dog                      
Breeding                         Agility Trials                   Jogging                          

How would you describe the ideal dog for you and your family? (Please be as specific as possible)

Have you ever owned a dog before?

 Yes No  

Have you ever owned a Retriever before?

 Yes No  

Please describe any concerns you have about the breed and reservations about dog ownership that you and your family may have in regards to the commitment, responsibilities, work, and resources required.

Who will be primarily responsible for the dog's care and training?

Please list all the animals that currently live in your household. Type/Breed , Sex, Age, Altered? # OF Years Owned , Where the animal is kept during the day and night?

How will you safely introduce and integrate a puppy with your existing pets?

What will be this dogs main purpose?

Which of the following best describes your current residence?

Single-family home Townhouse/condo/apartment

If you rent/lease, is your landlord agreeable to your owning a dog?

 Yes No  

Will you always be able to take your dog with you, and restrict your choice of housing to places where pets are allowed if you have to move anytime in the next 15 years?

Is someone normally at home most of the day?

 Yes No

How many days will the dog be alone in a normal workweek? How many hours per day?

How do you plan to exercise and relieve your puppy when you are at work?

Where will your Golden spend most of the day? (Please be specific.) ie. Run of the house, Loose outdoors, Tied up outside, Kennel run or fenced yard, Spend-time in Crate, Restricted to certain areas

Where will the dog sleep at night? (Please be specific.)

Who will be the main persons responsible for exercising the dog and discribe how regularly and for how long the dog will be exercised?

Please list any dog you have owned in the past Name, Type/Breed, Sex, Age, Altered, # OF Years Owned, What happened to it?

Have any of your dogs had puppies or fathered a litter?

Are you interested in having puppies with this dog?

Based on your past dog experience, is there anything you might do differently with your next dog?

Please provide the following Veterinarian's information:

Have you ever trained one or more dogs?

True False

Would you be willing to participate in formal obedience training program with your Golden?

Yes No

Are you familiar with crate training?

Yes No

Will you be crate training this puppy?

Yes No

How would you describe your attitude about training (firm, tolerant, lenient, etc?)

How would you discipline your dog if he made a mistake?

A Golden Retriever can live to be 15 years. Are you and those living with you committed to spending the next 15 years providing health care, food, grooming, training, and attention to your Golden?

True False

Have you carefully considered how the dog will fit into your current lifestyle, and how dog ownership will change your daily routine and schedule?

If you're getting a pet for children will you still want the dog after the kids have grown up and moved out? Where will the dog go if not?

Thank you for taking the time to complete this questionnaire. Your answers will permit us to more effectively match the right puppy with your lifestyle and requirements.
Jamie Veraldi

Signature of Applicant:

DATE :