Name:
Address:
City State/Province, Zip Code:
Phone:
Email:
When are you looking to add a golden retriever to your family?
Describe your family:
Why have you decided to buy a golden
retriever?
Are all family members in agreement on getting a dog? Yes
No
Are all family members in agreement on getting a golden retriever?
Yes No
What type of housing do your live in? Choose one:
Where will your dog live?
Do you have a securely fenced yard? Yes
No
Do you have a pool? Yes
No
If so, is is separately fenced? Yes
No

Are you aware of the care requirements
of a golden retriever?
Yes
No
Are you aware of the grooming requirements
of golden retrievers? Yes
No
Are you aware of the attention and exercise requirements?
Yes
No
Are you aware that goldens shed a lot?
Yes
No
What breeds of dogs have you owned in the past?
What has happened to the dogs you've owned?
Do you prefer a male or female and why?

Is someone home through the day?
Yes
No
If not, what arrangements will you make?
How will you housetrain your puppy?
How will you obedience
train you puppy?
For what purposes are you buying your puppy? Check all that
apply ....
Pet Show
Obedience
Field
Agility
Pet Therapy
Breeding
Other
If for breeding are you
aware that the puppy will be sold on a Non-Breeding Agreement
pending fulfillment of the criteria as set out in our
Agreement of Sale?
Yes
No
Have you ever been in any AKC or CKC competitions and put any titles on your
dogs?
Yes
No
If yes, please describe:
Have you ever bred dogs? Yes
No
If yes, please explain:
If you have a veterinarian may we contact him/her for a reference? Yes
No
Please provide his/her name, address, and phone number:
Please list two other references with contact information that we may
contact:
If you've had dogs
before, please list from whom your other dogs were purchased:
Please include any other information you feel would be helpful: