Puppy Questionnaire

 NAME

 

 (Complete as name to be shown  on Registration including co-owner, if any)
ADDRESS

CITY

 STATE   

ZIP  

HOME PH

     WORK PH 

EMAIL

   CELL PH 
HOW LONG HAVE YOU LIVED AT THIS ADDRESS?  
REFERRED BY:
 
BREED INFORMATION:
HOW DID YOU HEAR ABOUT THIS BREED?  
WHAT REFERENCE MATERIALS HAVE YOU READ?
WHAT DO YOU EXPECT THE ACTIVITY LEVEL OF THIS BREED TO BE?
VERY HIGHHIGHMODERATEBELOW AVERAGE
TYPE OF DWELLING:
HOUSECONDOAPARTMENTMOBILE HOME
WHAT KIND OF FLOOR SURFACES WILL THE DOG BE ON IN THE HOUSE?  
IF RENTING, PLEASE GIVE CONTACT INFORMATION OF LANDLORD:
NAME:         
ADDRESS:   
PHONE:        

FAMILY STATUS:

SINGLE     
MARRIED - SPOUSE NAME: 
PARTNERED - PARTNERS NAME:
ROOMMATES - ROOMMATES NAME:
DOES ANYONE IN YOUR HOUSEHOLD HAVE ALLERGIES TO ANIMALS?     YES NO
IF YES, TO WHAT AND HOW SEVERE?   
CHILDREN LIVING AT HOME: 

 NOYES - NAMES AND AGES:   
PUPPY GENDER PREFERENCE:
MALEFEMALE     WHY : 

WHAT ARE YOUR PLANS FOR YOUR AMICUS PUPPY?
SHOW DOG  OBEDIENCE   AGILITY   HOUSE PET  THERAPY DOG   
HAVE YOU EVER SHOWN A DOG TO IT'S CHAMPIONSHIP?YESNO
HAVE YOU EVER SHOWN A DOG TO ANY PERFORMANCE TITLES?YESNO
DO YOU INTEND TO BREED THE DOG?YESNO
IF YOU ARE INTERESTED IN A SHOW DOG, DO YOU PLAN TO USE A HANDLER?  IF SO, WHOM?

PREVIOUS DOG EXPERIENCE:
HAVE YOU EVER OWNED A DOG BEFORE? YESNO
HAVE YOU OWNED A GOLDEN RETRIEVER BEFORE?      YESNOSTILL DO  

LIST DOGS CURRENTLY OWNED INCLUDING BREED, REGISTERED NAME, AND TITLES:

LIST DOGS PREVIOUSLY OWNED INCLUDING BREED, REGISTERED NAME, AND TITLES:
HOW LONG DID YOUR LAST PET LIVE?  WHAT WHERE THE CIRCUMSTANCES OF ITS DEATH?
DO YOU HAVE ANY OTHER ANIMALS?NOYES - PLEASE LIST:        

REASON FOR WANTING AN AMICUS PUPPY:

ARE YOU CURRENTLY A MEMBER OF A DOG SHOW CLUB, OBEDIENCE CLUB, OR OTHER DOG CLUB?   LIST CLUBS IN WHICH YOU ARE A MEMBER.
WILL YOU BE ATTENDING ANY TRAINING CLASSES?YESNO
IF YES, AT WHAT AGE WILL YOU START? 
WHICH ACTIVITIES/COMPETITIONS ARE YOU INTERESTED IN AND WHO IS THE TRAINER?

HOW FAR WILL YOU TRAVEL TO GET YOUR PUPPY?
WHAT AGE DO YOU WISH TO GET YOUR PUPPY?  
HAVE YOU CONSIDERED AN OLDER DOG INSTEAD OF A PUPPY?YESNO

IS SOMEONE HOME DURING THE DAY?YESNO
WHO WILL BE THE PRIMARY CARE GIVER?  
HOW LONG WILL PUPPY BE LEFT ALONE?
HOW MANY HOURS A DAY WILL THE PUPPY BE KEPT OUTSIDE?    
WHERE WILL PUPPY BE KEPT AT NIGHT?
WHERE WILL PUPPY BE DURING THE DAY?
DO YOU HAVE A FENCED YARD? YESNO

APPROXIMATE SIZE:

HAVE YOU EVER HOUSE TRAINED A DOG BEFORE?YESNO
HAVE YOU EVER RETURNED A PET TO THE BREEDER?  IF SO, WHAT WERE THE CIRCUMSTANCES?
HAVE YOU EVER GIVEN A PET AWAY?  IF SO, WHAT WERE THE CIRCUMSTANCES?
HAVE YOU TAKEN A PET TO A POUND OR SHELTER?  IF SO, WHAT WERE THE CIRCUMSTANCES?

CURRENT OR PRIOR VETERINARIAN FOR REFERENCE:

NAME:         

ADDRESS:   
PHONE:          
 
DO YOU UNDERSTAND THE DIFFERENCE BETWEEN LIMITED AND FULL REGISTRATION?    
  NOYES 

(WHEN YOU CLICK [SUBMIT] THIS FORM WILL BE EMAILED TO AMICUS)