Shalyn Flat Coated Retrievers

My goal is to place each of my puppies in a well suited home where the puppy will meet the owner’s expectations and the owners will provide a home that matches the puppy’s personality and takes advantage of the puppy’s talents and skills. To help with this process, I ask that you completed the following questionnaire to formalize your interest in one of my puppies. Acceptance of this form by Shalyn Flat Coat Retrievers does not guarantee you a puppy but will enable you to be considered for one of my pups. Please attach additional sheets or use the back of the form if you need more space. Return your completed questionnaire via e-mail or regular mail.

Personal Information

Name:______Age:______

Spouse/Partner Name:______Age:______

Address:______

City, State, Zip:______

Home phone:______Work:______Cell:______

E-Mail address(es):______

Your Employer:______Occupation:______

Spouse/Partner Employer:______Occupation:______

Do you have children?______If so, what are their ages?______

If you do not have children, are you planning on adding to your family?______

If so, when?______

Puppy Expectations

How did you hear about me:______

Why do you want a Flat Coated Retriever:______

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Are you aware of the hereditary health problems that affect the breed?______

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If not, please contact me so we can discuss them.

Do you prefer male or female? If the sex you prefer is not available, would you consider the opposite sex?______

Why do you have a preference for one sex or the other?______

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Since you are primarily purchasing this puppy as a pet, do you have any objection to spaying or neutering it?______

Are you willing to wait until your pup is at least 12- 18 months of age and, if female, has had at least one season before neutering or spaying?______

I sell my puppies on non-breeding contracts with AKC limited registrations, which means they are not to be bred and their offspring cannot be registered with the AKC. Are you willing to accept this contract and registrations? If not, contact me to discuss. ______

How would you describe the personality or specific traits you are looking for in your new dog? Do you want a couch potato, an active dog, etc? (Please be specific about energy level, drive, confidence, dominance/submission, independent, cuddler, appearance or anything else that is important to you in your dog.)______

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Are you primarily interested in a dog that will be your pet? Do you plan to show your dog or do any other activities or competition with your dog? If so, what?______

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Are you on any other breeders’ puppy list? If so, whose?______

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Are you planning on getting another puppy during the next year? If so, please provide details on breed, sex, breeder and goals for that puppy.______

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Home Information

Do you own/rent, live in a home/condo/apartment?______

Do you have a fully fenced yard? Is it dog proof? What kind of fencing? How tall?______

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How much traveling do you do during the year?______

What arrangements have or will you make for the dog while you are away?______

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Do you or anyone in your household smoke?______

Pet Ownership History

Please tell me a little about the other pets you have now. What kind are they? What are their sexes and ages? For dogs, list your dogs breed, registered names, titles if any.______

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Please tell me a little about your past dogs. What breed were they? List their registered names, titles. ______

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If any of your dogs have been lost or died, please explain the circumstances.______

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My Expectations of You

Keeping a Flat Coat Retriever is not an inexpensive venture, between quality food, veterinary care, and training. Are you confident that you know how much this dog will cost you to maintain and that you have the resources to do so?______

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How do you feel about testing your flat coat for various genetic diseases that flat coats are susceptible to, including x-rays for hip and elbows, an examination by a board certified cardiologist and ophthalmologist for eye and heart problems.______

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Testing is done between 24 and 30 months of age. Average costs for all tests are $500-$700.

Do you agree to provide results to me?______

Lifestyle

Where will your pup spend most of his/her day?______

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Once grown, where/how will your dog spend most of his/her day?______

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Where will puppy/dog spend his/her nights?(ex. Crated in the bedroom, alone in kitchen, in garage?)______

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For what periods of a normal day will your dog be left alone?______

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Will you be able to spend more time with the puppy when it first comes into your home? What arrangements have or must you make to do this?______

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Does your job require you to move frequently?______

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I send all puppies in a litter home at the same time and prefer not to hold puppies past this period. Do you have any vacations planned for the next year that might limit when you can pick up your puppy? If so, when?______

The first 16 weeks of your puppy’s life is critical. Do you have any vacations planned in which you would not be able to include the puppy and thus would have to leave your puppy with someone other than an immediate family member? If so, when?______

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In what ways do you think having this dog will change your lifestyle?______

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What is your family’s favorite forms of recreation?______

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Which of these activities would you include the dog in?______

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Feeding What do you feed your present dogs?______

What do you plan to feed your dog while it’s a puppy?______

What do you plan to feed your dog once it becomes an adult?______

Vaccinations Recently, the American Veterinary Medicine Association has changed its vaccine recommendation to fewer, less frequent vaccinations. For what diseases do you vaccinate your present dog(s)?______

How often do you vaccinate?______

Are you and your Veterinarian willing to use blood titers than vaccines to assess immunity? Please check with your Veterinarian before answering.______

Who is your Veterinarian?______

Address/Phone?______

Groomer?______

Control, Exercise and Training Do you allow your dogs or intend to allow future dogs to run loose? With or without supervision?______

How much and what type of exercise do you expect this dog will need and get each day?

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How much and what type of training do you expect this dog will need and get each day/week?

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I require all buyers to attend a Puppy Kindergarten class that includes free play among the puppies. Where will you and your puppy attend puppy kindergarten?______

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I prefer buyers to continue formal training with their dos for at least one year. Do you plan to do this? If so where? If no, why not?______

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Do you plan to train your puppy for field/hunting?______

If you are not already a member of the Flat-Coated Society of America or a local Flat Coat Club, are you interested in joining?______

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References

Please provide names, addresses and phone numbers of people who could verify your qualifications and lifestyle such as the breeders of your present dogs, dog trainers, training partners, friends, family, Veterinarian.

•Name______

Relationship to You______

Address______

Phone no#______

E-mail______

•Name______

Relationship to You______

Address______

Phone no#______

E-mail______

•Name______

Relationship to You______

Address______

Phone no#______

E-mail______

Please return to: Sherri Lilley-Peck

Shalyn Flat Coated Retrievers

111 Robin Lane

Smithfield, Va. 23430

(757)407-3105