Name *

First Name

Last Name

Phone

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you prefer a male or a female? *

Male

Female

If your first choice (male or female) is not available would you be willing to take a puppy of the opposite sex or would you wait for another litter? *

Wait for another litter

Willing to take opposite sex

Have you ever had to put a dog to sleep? *

Yes

No

What is the most important reason for purchasing a Golden Retriever?

(Please check all that apply)

Family Companion

Show Dog

Breeding Prospects

Obedience Competition

Agility

Pet Therapy

What type of personality are you looking for?

Couch Potato

Middle of the Road

Very Active

Independent

Other (Please describe below)

When this puppy is purchased as a family companion and is not going to be bred, do you agree to have it spayed after the first heat cycle or neutered after the age of 2 and submit a veterinarian certificate to the breeder as proof of surgery for her records? *

Yes

No

Is your yard completely fenced with secure fencing? If not, would you be willing to do so before bringing home a new puppy/dog or build a secure run for the puppy/dog to be in when not being safely supervised?

Securely Fence Yard

Will Fence Yard

Yard Not Fenced

Will Build Run

No Yard

Other (Please explain below)

Do any members of your family have any types of allergies to dogs?

Yes

No

Do the other members of your family also want to get a puppy?

Yes

No

Will you be willing to go to obedience classes if needed?

Yes

No

Do you have a veterinarian or would you like a recommendation?

Yes, I have a Vet

No, I do not have a Vet

Please Recommend a Vet

Do you have a swimming pool?

No

Yes, Fenced

Yes, Not Fenced

If you rent, have you checked with your landlord about getting a dog?

Yes, it is OK to have a dog

I have not checked yet