Britmore Golden Retrievers

Puppy Questionnaire/Adoption Form

Please take some time to provide us with some information about you, your family, lifestyle, and what kind of puppy you are hoping for. The future well- being of our puppies/dogs and the satisfaction of our prospective families are very important to us, please fill out the below Adoption Questionnaire/Puppy Adoption Form completely to help us know more about your potential home. We will be in touch soon.

Thank you for your interest in our puppies.

Adoption Questionnaire/Puppy Adoption Form

Reservations are made on a first come … first approved … first deposits received basis.

All information requested on this form must be completed in full.

Your full name: ______

Your occupation: ______

If married-Your Spouse full name: ______

(Spouse) Your occupation: ______

Your phone number (with country, city, area codes): _(_____)______-______

Your email address: ______

Your Home Address: / ______
City/Town: / ______State/Prov.: ___ Post./Zip Code: ______
Country: / USA

How did you hear about us? ______

Preference will be given to people with no preference in sex first.

With each reserved spot we will ask your preference as to male or female - but we are unable to guarantee the gender of your puppy until the litter is actually born. We cannot predict Mother Nature with 100% accuracy however we will do our best to provide puppies to as many on our waiting list as possible - dependent on the number and gender of puppies in a litter.

The more flexible you are in your choice of sex the easier it will be to meet your requirements. There is never any guarantee as to how many females (or) males will be born into any litter. Mother Nature does not give us the exact sex we want – we will have to wait and see. (If there is not a puppy of your preferred sex in the current litter you are waiting for – you can be ‘rolled’ over on the reservations waiting list until the next year’s upcoming litter). Reservations are made on a first come … first approved … first deposits received basis.

When would you like to add a puppy to your family? ______

Our first litter is expected in Spring 2017.

Are you willing to be rolled over on the reservations waiting list for our next litter if preferred puppy is not available this time? ____Yes /_____No

Note: Deposits will be 100 % returned only for the following reason:

There are not enough puppies born in the litter of your preferred sex written here on this puppy questionnaire/reservations list.

What sex are you interested in?

____ Female Only / ____ Male Only / ____ Either Male or Female

For what purpose(s) are you interested in a Golden Retriever? (check box)

Family Pet Obedience Agility Field Events Hunting

Our puppies are sold on Non-Breeding Contract and spay/neuter contract. Do you agree to sign and abide to this contract? _____Yes / _____No

If No, why? ______

Have you spoken with any other Golden Retriever breeders? ___Yes / ____No

If Yes, please list them (names/kennels) below: ______

Are you currently on the waiting list for any other litters? ______Yes / _____No

Do you have children under the age of 10? ______Yes / _____No

Please list the ages of your children: ______

Do you Rent or Own your residence? ______Rent / _____Own

How Long (years (or) months) have you lived at your current residence? ______

Do you have a fenced yard? ______Yes / _____No

What size yard do you have (appox.)? ______


If not, how will you provide safe environment/security for your puppy when its outside or when you're away?

______

Is there someone home during the day, or able to get home to "potty" a puppy?

______Yes / _____No *(if no, explain)______

*If no, how long would this puppy be left alone (max. time)? ______

Where will this puppy spend the day? ______

Will this puppy have regular contact with its family (or pet sitter) during the day?

______Yes / ______No

Where will this puppy sleep? ______

Are you willing to attend "group" training classes with this dog?

_____Yes / ______No

Have you ever owned a Golden before? ______Yes / ______No

Below – please tell us about your other pets (list the pets that you have had in the last five years or still have): * (Please include Name, Breed, Age, Sex, Altered, any other important information)

______

Are all your pets current on vaccinations? _____ Yes / _____ No

Will you ensure that your new puppy is kept current on all vaccinations and visits the vet for boosters shots/annual exam once a year? _____ Yes / _____ No

If you haven't owned a Golden before, what other breed of dog have you owned? ______

(If you haven't owned a dog before, please state.) ______

______

If any of the dogs owned are deceased, what were the circumstances?

______

Do all family members agree on the addition of a Golden to the family?

_____ Yes / _____No

Who will have primary responsibility for the care of this puppy? ______

Have you ever given up a dog to a shelter or pound? _____ Yes / _____ No

If so, why? * (Our pups/dogs must be returned to us.)

If you have previously owned a dog, please give us the name, address, and phone number of your vet (or one that has worked with you in the past):

Your Vet’s Name and Address: ______

Your Vet’s Tel. No.: (______)______-______

We Require at Least 2 Personal References (not related to you) and their phone numbers?

1. Name: ______Phone Number:_(______)______-______

2. Name: ______Phone Number: _(______)______-______

What type of personality are you looking for in your dog / what are the three most important qualities you are looking for in your future golden? ______

The total purchase price for a pet puppy (AKC Limited Registration) is: $2000.00

Deposits to hold your place on the list for this litter is $500.00.

Please make checks payable to Andrea Sahs. Please DO NOT make checks out to Britmore Golden Retrievers.

We strive to make sure that any puppy adoption is a perfect fit for you, your family and puppy.

Please complete, scan, sign & email back to us this completed form or return to us via US mail - our mailing address is below. If you have any questions at all, please feel free to give us a call.

Please sign & date below.

______

Signature Date

______

Print Full Name

We will be in touch soon. THANK YOU.

Britmore Golden Retrievers

Andrea Sahs

6119 Pershing Ave

Downers Grove, IL 60516

Phone: 630-669-3766

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