All information in this questionnaire will be kept in strict confidence by
me and not used by anyone else!
1. How did you hear about us?
2. Your name:
3. Your address:
4. Your Phone Numbers:
5. Email Address:
7. What days and hours do you work:
8. Spouse's Name:
9. Spouse's Occupation:
10. Do you have children and if so, please list their names and ages:
11. Why do you want a Golden Retriever? Please select the one(s) that apply:
12. Do you prefer a male or female? Please explain why:
13. If your first choice is not available, would you be willing to take one of
the opposite sex, one of a different colour, one from another litter, or would
you prefer none of the above?
14. What are you looking for in a puppy/dog?
15. Is everyone in the family ready for a dog?
16. Does anyone in the family have allergies to dogs? If so, who?
17. What type of housing do you live in? Apartment, condominium, house, etc.?
18. Do you own or rent?
19. If you rent, does your landlord allow dogs?
20. Please list his name and phone number:
21. Is there a Home Owner's Association where you live, and if so, do they
permit dogs? What is the limit?
22. Name of the Association:
23. Do you have a fenced in yard? If so, how big an area does it
encompass, what kind of fencing does it have and how tall is it?
24. Do you own a pool? If so, is it completely fenced off?
25. Do you have other pets, and if so, please tell me what they are, their
genders, and their ages:
26. Are there any major changes that may occur in your life in the near future
such as moving, a divorce, relationship break up, new job, going to school or
other such thing? If so, please explain:
27. Do you agree to provide the proper care and love to this dog for the
duration of it's LIFE despite what changes may occur?
28. Have you ever owned a golden retriever before?
29. Do you know the pros and cons of this breed?
30. Who will be home with your new dog during the day?
And at night?
31. How long will your dog be left alone during the day?
32. If your new puppy/dog will be by itself for long periods of time, would
you agree to have someone come take care of it?
33. Are you willing to crate train your new puppy?
34. Who will groom the puppy/dog and how often?
35. Do you agree to feed this dog a top premium food for it's optimal health?
36. Will you provide this dog with the best medical care when needed?
37. Do you agree to never leave this dog outside in severe weather?
38. Do you agree to properly house this dog in clean quarters and provide it
with fresh water at all times?
39. Do you agree to never chain this dog to any stationary object such as a
tree or post, or leave it in the garage?
40. Do you agree to never let this dog run off leash in an unfenced, unsecured
41. Do you agree to never let this dog ride in the back of an open vehicle?
42. Who will train this dog? Are you willing to take it to classes so it
becomes a good canine citizen?
43. Do you agree to spay/neuter this dog if it is a family companion and send
the breeder a copy of the certificate?
44. If this dog is being purchased for show or breeding purposes, do you plan
to title it?
45. In the event you cannot keep this dog, would you be willing to give the
breeder first option to take it back?
45. If for some reason the dog can not be returned to the breeder, would you
be willing to let her help you find a new home for it?
46. Are you willing to stay in contact with the breeder and give her
occasional updates on how your dog is doing for the duration that you have it?
47. Please provide THREE references with their names, address's and phone
numbers (one can be your vet if you have one):
I hereby swear that the content in this questionnaire is the truth to the best
of my knowledge.