Please copy & paste the following information with questionnaire completed and e-mail to DSupern274@aol.com Subject puppies or print out application and mail to_
Dawn Supernault
Goldenbrook Goldens
6202 Lakeshore Rd, Cicero, NY 13039
(315) 698-8896
Personal Information: Please Print
Name: Name:__________________________________________________
Address:______________________________________________________ City,State,Zip: _______________________________________________________________________________________ Phone: ______________________________E-mail: ___________________________
How did you here about Goldenbrook_________________________________________
__________________________________________________________________________
Do you have children? __________ How Many:___________ Ages:_____________________________
Have they been around puppies and dogs? ___________________________________
Are they scared of puppies or dogs?_________________________________________
If yes, please explain: ____________________________________________________
________________________________________________________________________
________________________________________________________________________
Does anyone in your house have allergies to dogs? ______________________________
Do all family members agree on the new addition of a golden to the family? ____________
Why have you chosen this Breed?_______________________________________
Have you done research on the Golden retriever? __________________________
What are your plans for this puppy? ______________________________________
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Pet History:
Is this your first dog? __________________ Do you have pets now? ______________
Please list all pets in your household(If necessarily please list on back of paper.)
Type Sex Spayed/Neutered Where are they now
_________ _______ ________________ _____________________________
_________ _______ ________________ ______________________________
_________ _______ ________________ ______________________________
If not, what happened to them?____________________________________________ ________________________________________________________________________
Do you take your pets to a veterinarian? ______________________________________
Are they current on there vaccinations? ______________________________________
Do you have a veterinarian that is familiar with you? ____________________________
If yes, may we contact them? __________________________________________
Name of Veterinarian: ______________________________________________________
Address: _______________________________________________________________
Phone: _________________________________________________________________
If you don't do you plan on getting one for your new puppy? ____________________
Are you willing to let me call you to see how things are going? __________
Will you send picture's of the puppy growing up? ___________
Household Information:
Do you live in a: ___House ___Apartment ___ Townhouse ____ Duplex
Do you : ___ Own ____ Rent ____ Lease
If renting or leasing, please provide landlords information:
Name: _______________________________________
Address: _____________________________________
Phone: _______________________________________
Is your yard fenced? __________
If you don't have adequate fencing( I.e totally enclosed secure fencing), how will you provide bathroom time, as well as regular exercise. and who will supervise these outdoor activities?____________________________________________________
Do you have a pool? _________ Is the pool fenced to prevent the puppy from unsupervised swimming? _________________________________________
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Will this dog be an outside or inside dog? ___________ How long will the puppy be kept outside? ____________________________________________________
Will the puppy have shelter( like dog house) and water?________________________
Puppy & Care Information- this will guide us in finding the best suited puppy
What are you looking for? ___ Pet ___ Showing/Breeding ___ Gift
If gift, please explain: ____________________________________________________
Sex: ____Male ____ Female If female, please explain: __________________________
_________________________________________________________________________
What type of personality are you looking / activity level? ________________________
________________________________________________________________________
Are you willing to take care and take responsibility for this pet for the next 10 plus years? _______________
Is this your first golden? _____________________
Are you aware that Goldens are a large breed dog? And they need plenty of exercise: ________________________________________________________________________
Are you aware that Goldens shed, sometimes quite porously. And need daily brushing? _______________________________________________________________
Did you know that you cannot over exercise a golden under 18 months?___________ ________________________________________________________________________
Will someone be home all day the first few day home with your new puppy?________ _________________________________________________________________________
How many hours will the puppy be left alone? _______________ Will it be crated? _________________________________________________________________________
Are you going to crate train your puppy? _____________________________________
Will this puppy be going to puppy classes? __________________________________
Who will be caring for this puppy? ___________________________________________
Are you willing to contact me with and questions or problems you might have with your puppy?_________________________________________________________
Are you willing to return the puppy/dog at anytime in its lifetime, or if you no longer can care for him/her. Or if the new family member is just not working out. And you will contact me as soon as possible?_________________________________________ ___________________________________________________________________________________
References: Please list 3 references. Do not use family or relatives
___________________________________________________________________________
Name/Phone/E-mail
___________________________________________________________________________
Name/Phone?E-mail
__________________________________________________________________________
Name/Phone/E-mail
Any comments or questions? __________________________________________________________________________
__________________________________________________________________________ __________________________________________________________________________
If you feel that any additional information would be helpful, please add on reverse side.
Applicant Signature'(s)
I acknowledge that the information contained in this form is to be true and correct. And I understand that completion this questionnaire does not guarantee that I will be offered a puppy for purchase, and that Goldenbrook Goldens has no obligation to provide me with a puppy.All information will be kept confidential and only be used by Goldenbrook.This questionnaire will become part of your contract. There is a $100.00 non re-refundable deposit fee. Once approved you will be placed on a waiting list until the puppy comes available.
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Signature of Applicant & Date
_____________________________________________________________________________
Signature of Applicant & Date
Simply submitting this questionnaire DOES NOT place you on any potential puppy reservation list. You must be approved and contact will be made upon approval, before any deposits are accepted for any upcoming litters.
Thank you
Dawn Supernault
Goldenbrook Goldens
315-698-8896
Copyright 2007 Goldenbrook Golden's, All Rights Reserved
