Potential Puppy Owner Questionnaire
Ely’s Fabulous Goldens
Your assistance in completing this questionnaire will help us place the right puppy with you. While it is not our intent to be intrusive, these questions help determine whether a Golden Retriever is the right breed for you and helps ensure a good match. If you feel additional information would be helpful, please add additional pages as necessary. All information is confidential. Thank you for your interest in Ely’s Fabulous Golden Retrievers.
City:________________________________________ State:____________ Zip:________________
Your Occupation(s):__________________________________ E-Mail:________________________
Full Time:______ Part Time:______
List the names and ages of all members of your household:_______________________________
What other breeds are you considering at this time?:_____________________________________
How did you first learn about the Golden Retriever?
How did you first learn of Ely’s Fabulous Goldens?
Why does the Golden Retriever appeal you?
For what purpose do you wish to purchase a Golden? (Check as many as applicable):
Companion____ Show Dog____ Obedience____ Breeding____
Do you prefer a male_____ or female_____ puppy? Why?________________________________
Are any members of your household allergic to dogs and/or cats?_________________________
Are there any members of your household who DO NOT want a new puppy?_______________
Is your current Residence a house_____ apartment_____ condo_____ other_____?
Do you own_____ or rent_____?
If you rent, does your current lease permit you to have pets?_____________________
Please give the name, address and phone number of your current landlord:______________
Does your current residence have a yard?____________
If yes, please state the general dimensions of your yard:____________________
If you have a yard, is it fully enclosed?______________
What is the height and type of fence which encloses your yard?__________________________
Where will your Golden be kept during the day? House_____ Yard_____ Dog Run_____
Other, please indicate:_______________________________________________________________
Where will your Golden be kept during the evenings? House_____ Yard_____
Dog Run_____ Other, please indicate:________________________________________________
An adult Golden requires regular exercise. How do you intend to exercise your dog?_______
How many hours per day could you spend with your Golden on a typical weekday?_________
How many hours per day could you spend with your Golden on a typical weekend?_________
Do you have any time-consuming hobbies or interests which you feel may affect the time available to spend with your Golden?
Who in your household will be the primary caretaker(s) of your Golden?
Are any of these persons under the age of 18?___________________________________________
Do you understand that our “companion only” puppies are sold on a “limited registration” basis which under AKC rules means your Golden Retriever is registered as a purebred but ineligible for breeding?
Please list all pets you currently own:___________________________________________________
Please list the name, address and phone number of your pets’ current veterinarian:_________
Please list all of the dogs you have owned in the past ten years including the following information:
B) Where you obtained your dog(s)
C) Sex of dog and whether it was spayed or neutered
D) What became of the dog(s) (i.e. death, sale, gift, theft, etc.). If by death, please state the cause of death and approximate age of dog at time of death:
Are you committed to taking care of your Golden Retriever’s needs for its entire lifetime?_____________
Are you willing to take your Golden puppy through a formal class-oriented obedience program?____________________________________________________________________________
Have you ever completed an AKC title on a dog in either conformation_____ or obedience_____ or other?_____
List titles completed:__________________________________________________________________
Have you ever bred a litter of puppies?_____ If yes, please state the number of times and all information pertaining to these breedings:___________________________________________
If you are considering breeding this dog, are you willing to obtain all necessary health clearances required under our puppy sales contract, including screening for hip and elbow dysplasia, thyroid and eye abnormalities?_______________________________________________
If you are purchasing a “companion only” puppy, are you still willing to obtain all necessary health clearances listed above so that we can maintain records of our Golden Retrievers in order to ensure the highest of breeding standards?______________
Please complete this form and return to:
Teresa A. Koch-Ely at email below