Name: __________________________________________________
 

Address: _________________________________________________
 
City: _____________________________

State/Zip: _________________________

Home: ____________________________
 
Work/Cell: _________________________

Email: ____________________________

Purchasing Question:


Are you looking for a male or female puppy?

Do you plan on picking up your pup (driving), flying to meet us at the airport, or having us ship your pup to you?

Questions about you, the buyer: We kindly ask that you reply to the following questions -- these questions are not meant to be judgmental in any way. Please feel free to add any additional comments. Completion of this questionnaire is in no way a guarantee that a puppy will be sold/reserved to/for you.

Number of members in your family?
 

Do you have children? (please include ages)/

Are all members of your household away during the day?
How many hours a day will the puppy be alone?
If so, what provisions will you make for your puppy at that time?

Does anyone in your family suffer from allergies?

Does anyone who lives in your home, or who is a frequent visitor, a smoker?
 

Do you own a swimming pool?
If so, is it fenced separately from the yard, with no entrance under it?
 

Have you put a deposit on a puppy with anyone else at this time? If so who?
 

Do you own your own home or do you rent?
If you rent, does your landlord allow dogs?
 

Have you owned a dog before?
What breed/type did you own and what happened to them?
 

Do you currently have any pets (and age)?

Will they adapt to another animal in the family?
 

How did you decide on a Golden Retriever?
 
Why do you want a puppy?
 
What will you do with the puppy if it does not work out for you?
Do you agree that if at any time you are unable to keep your puppy or dog, for whatever reason, you will need to return the puppy/dog to Golden Reflection kennel and we will find place him/her in a suitable home?
 
Where will your dog live?, Sleep?, Eat?, and Play?
 
Do you have a fenced yard, or fenced exercise play area for your dog?
If not, are you willing to construct one of these before puppy comes to live with you?
 
Do you know that we will not allow a puppy obtained from us to be tied in any manner?
Do you understand why we insist on this?
 
Do you understand that Goldens thrive on human attention and cannot be isolated from the rest of the family?

Do you understand that a puppy purchased from us must be a part of the family and not be a dog that lives outdoors all the time?
 

What Veterinarian do you plan to use? (Name, address, & phone number)
 
Please list 2 references of people that know you, your family/work life, and any past relationships with pets (with address/phone #'s).

Do you plan on using a crate to help house-train your pup?
If not, how do you plan on house-training?
 
Who will be responsible for the care, grooming, and training of your dog?
 
Are you interested in doing any other type of training with your dog? (Obedience, Agility, Hunt Trials, Tracking etc.)

Briefly tell us about your family’s lifestyle, hobbies, and interests:
 
Briefly tell us the attributes you would like your puppy/dog to possess?
 
What do you expect from us, the breeders of your pup?

Are you prepared to feed a premium dog food to your dog?
 
Do you understand that your dog must be neutered/spayed?
Do you understand that we sell all our puppies on a non-breeding contract as required by the Golden Retriever Club of America, that it may not be bred unless this contract is removed by mutual consent?
 
If you decide to purchase a pet puppy from us, do you understand that the deposit ($250) that you give us to reserve a puppy for you is non-refundable (unless we do not have a puppy for you or the sex of puppy which you requested)?
 
Do you have any problem with natural care and supplements for your dog?
 
Will you allow a home visit by the breeder or breeder’s representative (if to far away) before a puppy is placed in your home?

Do you agree to all the conditions and state that the information provided by you is accurate and true?

Signed: ________________________________________

Dated:  _______________

ARE YOU AWARE: (answers not needed)

Golden Retrievers need lots of exercise to keep them happy?

Goldens shed copious amounts of hair twice a year and smaller amounts throughout the year?

Goldens require regular brushing to keep the shedding and tangles under control?
Goldens need periodic grooming to prevent matting and hot spots, as well as ear infections?

Even with regular grooming, you will always have a bit of dog hair on your clothing and/or furniture?

Goldens mature slowly and some Goldens are forever puppies in attitude?
Golden Retriever puppies have a lot of energy and unless that energy is discharged they can become destructive?

Goldens are relatively high energy and require a great deal of your time and attention daily?

Goldens have a real need and want to carry things. Therefore, they will carry/chew and/or swallow whatever you leave on the floor?

Goldens need the company and companionship of people and are happiest when they are with people. They were developed as a breed to have this characteristic.

Even though the breed is noted for being good with children, they should not be left unsupervised with small children?

Even though the breed is noted for being calm and easy going, people-loving dogs, they are still dogs and behave like dogs?

Even though the breed is known for being well behaved and intelligent, good behavior from a Golden requires training on your part?

Some Goldens believe that they are more intelligent than their owners and can be quite stubborn?

Goldens do not come fully trained?

Goldens will become your best friend?

Goldens do not think like human beings?

Goldens learn by repetition so it is very important to be consistent when training?

Even though every precaution has been taken to prevent health problems, Goldens are subject to hip dysplasia, joint disease, epilepsy, heart disease, allergies, thyroid problems, cataracts, retinal atrophy, and cancer?

We are now seeing a rise in temperament problems in the breed. Once again, we have taken every precaution to prevent this (by doing temperament tests), but you should be aware that it could occur and that early training and proper socialization is an important factor in any Golden Retriever’s good behavior and life.

I have read the above and understand fully the implications as written:

Signed:_____________________________________________
 
Dated:_______