First Name

Last Name

Address

City

State

Zip Code

Home Phone

E-Mail 

Your Occupation

Spouses Occupation

Why have you decided to purchase a Golden Retriever?

Do you prefer:   Male Female No Preference

For what purpose(s) are you purchasing a Golden Retriever?
Family Pet Performance prospect (obedience, field, agility etc) To breed to my male To breed to my female

Do all family members want a new puppy?  (yes/no)

Are there children in the Family?  (yes/no)
Please list the gender & ages:

Do any family members have allergies to dogs?  (yes/no)

Have any family members ever been bitten by a dog?  (yes/no)
If yes, please describe below:

Are any family members afraid of dogs?   (yes/no)
If yes, please describe below:

Do you: Own Rent Lease  your principal residence.        Do you live in a: House Townhouse Apartment

Where will the puppy be accommodated during the day: House Crate in house Dog run with dog house Yard with dog house Chained in yard

If other then please describe:

Is someone home during the day, or able to get home to "potty" the puppy? (Yes/No)

If "no", what kind of arrangements will you be making for your new puppy?

Do you have a securely fenced yard?   (yes/no)

What type of fence do you have? Chainlink 4 foot Electric fence Field/hog fence Chainlink 6 foot or higher Solid wood 4 foot Solid wood 6 foot or higher Plastic molded solid 4 foot Plastic molded 6 foot or higher Slatted fence

Do you padlock your gates?  (yes/no)

Do you have a chain link kennel run?   (yes/no)

If yes, what is the size?

Are there neighborhood restrictions on owning a dog?  (yes/no)

If YES-Please describe what they are in detail below:

Are you committed to care for this dog's needs for his/her lifetime?  (yes/no)

Do you have other pets?  (yes/no)
If yes, please describe (breed & age)

In our contract we require all puppy buyers complete a series of obedience classes so that he will become an enjoyable companion and a good canine citizen? Do you agree to complete these classes?  (yes/no)

Have you ever owned a puppy?  (yes/no)
If yes, when and what breed?

Who will primarily train this dog?

Have you ever crate trained a puppy or dog?  (yes/no)
If no, please describe why not:

What type of personality are you looking for in your puppy?

 

Are you willing to spay/neuter this dog?   (yes/no)

If no please describe in detail why not.

Have you ever bred a litter of puppies    yes/no

If yes please describe below:

Please include anything else that will help us place the right puppy with you:

Reference(s)
Please name 2 person (s)  that we could contact for references.
Please include one being name of the veterinary clinic who knows you if possible.
List name (s), phone number (s) and email (s)
  

I understand that sending this application does not automatically entitle me to a puppy from Kilowatt Goldens/Kristi Sachtleben.

I understand that this application is just a beginning step in the interview process.

Please review and then submit this completed questionnaire. 

We will contact you via e-mail as soon as possible regarding the availability of our Kilowatt puppies.