Acadia Golden Retrievers Puppy Adoption Questionnaire Date:_____________________ Litter: ____________________ Owner (Buyer):________________________________________ Co-owner, if any:_______________________________________ Physical Address:______________________________________ _______________________________________ Mailing Address:_______________________________________ (if different) ________________________________________ E-Mail Address: _______________________________________ Phone #:______________________ Work/Other Phone # _______________________ Sex Preferred: Male______ Female______ If necessary, would you take the opposite sex? Yes___ No___ Purpose: ________Show ________ Pet ________ Other - explain: ________________________________________________________________________ ________________________________________________________________________ We kindly ask that you reply to the following questions. These questions are not meant to be judgmental in any way. The more information we have, the more able we will be to have some insight into your lifestyle and expectations. Please feel free to add any additional comments on a separate sheet of paper. Completion of this questionnaire is in no way a guarantee that a puppy will be available for you. Puppies’ personalities are matched with each buyer’s lifestyle, along with what the buyer has communicated they are looking for in a puppy, with the temperament testing, done at 7 weeks, being the final determining factor. 1. Where did you hear about us? _____________________________________________ 2. Number of family members: Adults: __________ Children: __________ 3.. Ages and sex of children: _________________________________________________ 4. Is anyone in your home afraid of dogs? Yes: __________ No: __________ If yes, please explain: _____________________________________________________ 5. Does anyone in your family suffer from allergies? Yes:________ No: _________ 6. Are all members of your household away during the day? Yes: ________ No:________ 7. If everyone is gone all day, who will come in during the day to feed and potty the puppy? _______________________________________________________________________ 8. How many hours in an average day would the puppy be alone? ____________________ 9. Do you own or rent? ______________ Renters must have a letter of permission from landlord before puppy can be taken. 10. Do you have a fenced yard? _________ What kind of fence? ___________________ 11. If you do not have a fence, how will you exercise your puppy? ______________________ _________________________________________________________________________ 12. Do you own a swimming pool? Yes:_______ No: _______ 13. If you own a swimming pool, is it fenced separately from the yard, with no entrance under it? Yes: ________ No: _________ 14. Where will the puppy live, sleep, eat and play? Inside:______ Outside: ______Both:______ 15. If you answered “Both”, please explain:_________________________________________ _________________________________________________________________________ _________________________________________________________________________ 16. Have you owned a dog before? Yes:_______ No: _______ 17. If yes, what breed/type did you own and what happened to them? ______________________ ___________________________________________________________________________ 18. Do you currently have any pets? Yes: __________ No: ___________ 19. If yes, please list types and ages of other pets: __________________________________ ________________________________________________________________________ 20. Will they adapt to another animal in the family? Yes: ________ No: __________ 21. How did you decide on a Golden Retriever? ____________________________________ ________________________________________________________________________ 22. Why do you want a puppy?__________________________________________________ ________________________________________________________________________ 23. Does everyone in your household understand puppy behavior? Yes: _____ No: ______ Important: Puppies will jump on you, can knock down young children, will bite during teething, and can grab clothing causing strangulation of a child, therefore, should never be loose with young children. All interaction with children should be closely supervised into adulthood. Puppies must be taught acceptable behavior through proper training which is done with love, not force. This can be done through puppy and advanced classes or individual instruction. 24. Does everyone in your household want a puppy? Yes:_______ No: _______ 25. Are you willing to properly train and socialize your puppy? Yes: _______ No: _______ 26. What will you do with the puppy if it does not work out for you? ____________________ _________________________________________________________________________ 27. Do you agree that if at any time you are unable to keep your puppy or dog, for whatever reason, you will need to contact Acadia Goldens for assistance in placing your golden in the manner that is best suited to your particular needs? Yes: ________ No:________ 28. Have you ever returned a puppy/dog to a breeder? Yes: _______ No: _______ 29. If yes, please explain: ________________________________________________________ ___________________________________________________________________________ 30. Have you put a deposit on a puppy with anyone else at this time? Yes: ______ No:______ 31. If yes, who? ______________________________________________________________ 32. Do you understand that we will not allow a puppy obtained from Acadia Goldens to be tied in any manner? Yes: _______ No: _______ 33. Do you understand why we insist on this? Yes:_______ No:_______ 34. Do you understand that Goldens thrive on human attention and cannot be isolated from the rest of the family? Yes: _______ No: _______ 35. Do you understand that a puppy purchased from Acadia Goldens must be a part of the family and not be a dog that lives outdoors the majority of the time? Yes: _______ No: _______ 36. Do you plan on using a crate to help house-train your puppy? Yes: _______ No: _______ 37. If not, how do you plan on house-training? _______________________________________ __________________________________________________________________________ 38. Who will be responsible for the care, grooming, and training of your puppy? ____________ __________________________________________________________________________ 39. Briefly tell us about your family’s lifestyle, hobbies, and interests: _____________________ ___________________________________________________________________________ ___________________________________________________________________________ 40. Briefly tell us the attributes you would like your puppy/dog to possess: _________________ __________________________________________________________________________ __________________________________________________________________________ 41. What do you expect from us, the breeders of your puppy? ___________________________ __________________________________________________________________________ __________________________________________________________________________ 42. Are you willing to follow our recommendations concerning weight, exercise and feeding a high quality natural/holistic diet? Yes: _______ No: _______ 43. Will you follow our recommendations of minimal vaccination? Yes:______ No: _______ 44. Do you have any problem with natural care and supplements for your dog? Yes:___No:___ 45. Are you prepared to care for a dog for 10+ years and incur the costs of veterinary care, grooming, diet, etc? Yes:_____ No:_____ 46. Do you understand that we sell our puppies on a non-breeding contract as required by the Golden Retriever Club of America, that is, our puppies may not be bred and must be spayed or neutered unless this contract is amended by mutual consent? Yes:_______ No: _______ 47. Once puppy visits start, will you be able to visit? Yes:_______ No:_______ 48. Would you allow a home visit by the breeder or breeder’s representative (if too far away)? Yes: _______ No: _______ 49. Can your name and e-mail address be given as a puppy reference? Yes: _____ No: _____ 50. If you do not currently have a vet, who do you plan on using? ________________________ __________________________________________________________________________ Veterinary Reference: ________________________________Phone: ___________________ Other Reference: __________________________________Phone: ____________________ NOTE: ALL PUPPIES GOING TO PET HOMES ARE SOLD ON LIMITED REGISTRATION. Limited Registration means that your puppy is registered with AKC but no litters produced by this puppy are eligible for registration. This is recommended by AKC and helps protect breeding programs. Dogs with Limited Registrations can compete in AKC obedience trials, field trials, hunt tests, agility, Junior Showmanship and NCA events. If a puppy buyer later decides he/she wishes to show the puppy at conformation events, the puppy can be re-evaluated by the breeder and if found to be show quality, the limited registration can be changed, by the breeder only, to a full registration and the sales contract can be amended to include the terms of our show contract. Reservation Deposits: If you decide you would like to purchase a puppy from Acadia Goldens and are willing to give one of our puppies a “forever home”, treat him/her properly, with gentle, loving guidance as a treasured family member and friend, we ask for a $200 deposit after birth to Hold a puppy, which will be deducted from the total price of the puppy. Deposits are 100% refundable - please see our web site for refund info. Approved homes who have reservation deposits, will receive a Puppy Packet after the birth, which contains various info on diet, exercise, training, etc, and will also receive e-mails with puppy pictures and weekly development updates. Please make all checks payable to “Patti Covert” and mail to: Acadia Golden Retrievers, c/o Patti Covert P.O. Box 301 Lemon Springs, NC 28355 Questionnaires can be e-mailed to: "mailto:Acadiagr@windstream.net" Thank you for taking the time to fill out our questionnaire. Please read the info contained on the “Puppy Info” page of our web site: www.acadiakennels.homestead.com By signing below, agree to all the conditions listed above and state that the information you have provided is accurate and true. Signatures of buyers and all other adults in the household are required. Other Adults: ________________________________ ____________________________________ Buyer Date Name and relationship to Buyer ________________________________ ____________________________________ Buyer Date Name and relationship to Buyer Please also sign the attached “Golden Retriever Fact Sheet.” AS ALWAYS, IF THERE ARE ANY QUESTIONS, PLEASE ASK! Golden Retriever Fact Sheet Are you aware: That Golden Retrievers need lots of exercise to keep them happy, however, exercise of a young puppy must be monitored, and not overdone, which can damage developing joints? That too rapid growth and obesity in Golden Retrievers can cause hip dysphasia? That Goldens shed copious amounts of hair twice a year and smaller amounts throughout the year? That Goldens require regular brushing to keep the shedding and tangles under control? That Goldens need periodic grooming to prevent matting and hot spots, as well as ear infections? That even with regular grooming, you will always have a bit of dog hair on your clothing and/or furniture? That Goldens mature slowly and some Goldens are forever puppies in attitude? That the Golden Retriever is a sporting dog - Golden puppies have a lot of energy and unless that energy is channeled through activity and interaction they can become destructive? That Goldens require a great deal of your time and attention daily? That Goldens have a real need and desire to carry things in their mouths, therefore, they will carry/chew and/or swallow whatever you leave on the floor, including but not limited to children’s toys? That Goldens need the companionship of people and are happiest when they are with people? They were developed as a breed to have this characteristic. That even though the breed is known for being good with children, they should not be left unsupervised? That even though the breed is known for being calm, easygoing, people-loving dogs, they are still dogs and behave like dogs? That even though the breed is known for being well behaved and intelligent, good behavior from a Golden requires training on your part? That some Goldens believe that they are more intelligent than their owners and can be quite stubborn? That Goldens do not come fully trained? That Goldens will become your best friend? That Goldens do not think like human beings? That Goldens learn by repetition so it is very important to be consistent when training? That even though every precaution has been taken by Acadia Goldens to prevent health problems, Goldens, as a breed, are subject to hip dysphasia, joint disease, epilepsy, heart disease, allergies, thyroid problems, cataracts, retinal atrophy, and cancer? Goldens are excellent companion dogs, however, we have seen occasional behavior issues arise within the breed. Once again, Acadia Goldens takes every precaution in selective breeding, early socialization, temperament testing, and compatibility placement in order to prevent such issues. You should, however, be aware that temperament problems such as stubbornness, food/toy possessiveness (demonstrated by growling), etc., could occur and that early training and proper socialization are crucial factors in a Golden Retriever’s good behavior. We can suggest several books that will help you with early training and highly recommend puppy classes. I have read the above and understand fully the implications as written: Signed:______________________________________________________ Date:______________________________