Who will be the primary care-giver?


What best descibes your home?
How long have you lived at your current address?


Is anyone home during the day?
Yes No

Will there be someone available to feed and exercise the puppy during the day?
Yes No
Where will the puppy be kept during the day?

Where will the puppy be kept during the night?

How many hours on average will the puppy be left alone?
1-3 Hours 4-6 Hours 7-9 Hours

Have you ever owned a dog before?
Yes No

Do you have any other animals?
Yes No

What other pets currently reside in your home (breed, age, sex)?


How long have you had them?


Do you currently have a vet?
Yes No

How long did your past pet live?


Have you ever given a pet away?


Have you ever returned a pet to the breeder?


Have you ever returned a pet to the pound/shelter?

Is anyone in the household allergic to animals?
Yes No
How severe? Slightly Moderate Highly

Please list the ages of the people(including children) living in your household:

Is everyone in home in agreement with the puppy?
Yes No
Has any member of your household been convicted or charged with animal cruelty?
Yes No
Do you own a fenced yard or suitable fence?
Yes No
What kind of surfaces do you have in your home?
(eg: tile, hardwood, carpet)


Average hours dog will be kept outside:
Never 1-2 Hours 3-4 Hours 5-8 Hours 9-12 Hours Over 12 Hours

Have you trained a dog before?
Yes No
Will you be attending any training classes?
Yes No
Who is the trainer?


What activities would you plan, if any, with your puppy?


If any, at which age would you start them at?

Do you prefer a male or female puppy?
Have you considered an older dog?
Yes, Intrested No, Not Intrested
What is the activity level of your desired dog?
Desired puppy:
Waiting List
How did you hear about the breed?
Friend Family Research Other
Do you have a puppy age preference?

If you rent, do you have your landlord's permission to own a dog?
Yes No
Please provide your landlord’s contact information to verify:
Name:

Mailing Address:

Are you interested in showing the dog in the conformation ring?
Yes No

Have you ever shown a dog to it's championship?
Yes No

Do you intend to breed the dog?
Yes No

Are you interested in competition in performance events such as obedience, agility, hunting, herding, etc.?
Yes No

Are you willing to stay in contact with the breeder?
Yes No

Are you willing to provide proof of routine veterinary care (annual checkups, routine vaccinations, testing, heart worm & year round flea and tick prevention)?
Yes No

Are you willing to sign a spay/neuter contract?
Yes No

Are you financially capable of caring for a dog?
Yes No

Note: Food and veterinary care costs can amount to more than $500 per year for a dog

Please provide two(2) references.
Additional references are helpful, but optional.

PLEASE CALL YOUR VET & PERSONAL REFERENCE AND LET THEM KNOW WE WILL BE CALLING.
This is important as most vets (and friends) won't give out information without your specific approval.

Name:

Mailing Address:


Phone number:


Why are they a good reference?

Name:

Mailing Address:


Phone number:


Why are they a good reference?

Name:

Mailing Address:


Phone number:


Why are they a good reference?

Name:

Mailing Address:


Phone number:


Why are they a good reference?

Name:

Mailing Address:


Phone number:

Additional Comments/Questions: