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Puppy Application

Puppy Application

Hello and welcome!Thank you for your interest in one of our puppies. Please complete the application below so we can get to know you better and ensure that our puppies are placed in the best possible homes. Our goal is to match each puppy with the right family, and we look forward to the possibility of welcoming you into the Effingham Retrievers family.
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    Owning a dog is a lifetime commitment. Our puppies are raised to be members of the family, and we believe bringing one home should never be taken lightly. We take pride in getting to know each family to ensure the best possible match for both the puppy and the owner. By completing this application, you help us understand your home, lifestyle, and what you are looking for in a puppy, as well as determine if we are the right breeder for your family. Are you ready to take this next step?
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    Please enter your first name.
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    Please enter your last name.
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    Please enter the email address you would like us to use for contact. While we primarily communicate by phone or message, an email address is required for our records. When payments such as deposits are completed, a receipt will automatically be sent to the email provided for your documentation.
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    Please enter your current physical address. This information is required for our records and to ensure accurate documentation.
    United States
    • Please Select
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • United States
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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    Please enter your phone number.This will be our main way of contacting you about your application and puppy updates. Most of the time, I will text so we both have a record of our conversations. I recently had a baby, so my schedule can be a little all over the place, but I will always respond as soon as I can.
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    Veteran, Active Duty, EMT, Police, Firefighter, Nurse, Teacher, or none of the above.
    Please Select
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    • Myself or my spouse is - A Veteran.
    • Myself or my spouse is - Active Duty
    • Myself or my spouse is - An EMT
    • Myself or my spouse is - A Police Officer
    • Myself or my spouse is - A Firefighter
    • Myself or my spouse is - A Nurse
    • Myself or my spouse is - A Teacher
    • Myself or my spouse is - None of the above
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  • 8
    Purchasing the puppy to be a service animal:
    Please Select
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    • Myself or someone in my household - is disabled
    • Myself or someone in my household - training the dog to be a service dog.
    • Myself or someone in my household. - none of the above
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  • 9
    If you do not have a color preference, please select all colors you would be okay with.
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    If you do not have a color preference, please select the last option.
    Please Select
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    • Male
    • Female
    • Either is fine
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  • 11
    Limited Registration $1000 - NO breeding rights Full Registration $1500 - Breeding rights
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  • 12
    Select as many that apply. If you know for sure who you want a puppy from, please make sure you ONLY select that mom.
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  • 13
    Please Select
    • Please Select
    • Yes
    • No
    • First time as an adult
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    Please Select
    • Please Select
    • Yes
    • No
    • No, but it's been a while!
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    Please Select
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    • Yes
    • No
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    We do not discriminate, we are just curious.
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    After experiencing a tragic loss due to veterinary malpractice after a routine procedure, we are very cautious about where our puppies receive care. We want to ensure that none of our babies are placed with that veterinarian we are not comfortable with, and owners who are not aware.
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    Please tell us about where your puppy will be living. We know things change and people move over time but tell us about your current living situation. 

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    Housing is not a deciding factor. We have placed many of our puppies in apartment homes and they have done great. Our goal is simply to make sure you choose the puppy that best fits your lifestyle, environment, and future.
    Please Select
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    • Apartment
    • Condo
    • Single Family Residence
    • Farm
    • Other
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  • 21
    Please Select
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    • Own this home
    • Rent this home
    • Rent-to-Own
    • Other: Staying with family
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  • 22
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  • 23
    Please Select
    • Please Select
    • Yes
    • No
    • Not sure
    • I'm sure we can work something out
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  • 24
    Please Select
    • Please Select
    • Yes
    • No
    • Not yet, but we're getting one
    • No, but we have a dog play area
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  • 25
    Please Select
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    • Yes
    • No
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    Please Select
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    • We will probably train the pup ourselves
    • Puppy classes
    • Professional trainer
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  • 28
    Again, this does not factor our decision. We ourselves have some who REFUSE to come inside and will tear the house down during bath weather to get back out even if we're trying to do them a favor!
    Please Select
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    • Mostly indoors
    • Mostly outdoors
    • Both
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  • 30
    Please Select
    • Please Select
    • No
    • Yes, and I need your help to pull off the surprise!
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  • 33
    Please Select
    • Please Select
    • Yes
    • Ouch. We'll make it work.
    • I need to think about this.
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  • 34
    Please Select
    • Please Select
    • Sure
    • No
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    Please Select
    • Please Select
    • Yes
    • No
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     Completing this application is part of the process of purchasing a puppy from Effingham Retrievers, but it does not guarantee you will receive a puppy from this or any future litter. While it is unlikely, the breeder reserves the right to refuse placement at any time. 

    Here at Effingham Retrievers, we consider all of our buyers family. Once you purchase a puppy from us, you will always be part of the Effingham Retrievers family. Below is important information to read before placing a deposit or purchasing a puppy.

    Deposit / Waiting List
    Deposits and waiting list fees are paid through Jotform, and the remaining balance is due in cash at the time of pickup.

    If you are sure you want a puppy and would like to be added to the waiting list for a planned litter, we require a $300 waiting list fee before the puppies are born. If you wait to place your deposit until after the puppies are born, picks will go in order based on the order deposits are received. Puppies are identified by the color of their collar. When it is your turn to pick, you will choose your puppy by collar color. If you have not already placed a waiting list deposit, a $300 non-refundable deposit is required to hold the puppy you choose until pickup. This deposit will be deducted from the total price. Your puppy will keep that collar color and will go home with it.

    Deposits are not refundable unless something unfortunate happens to the puppy while in our care. In that situation, you will have the option to:

    - choose a different puppy (if available), or
    - move your deposit to a future litter.

    If you decide you can no longer get your puppy, deposits are not refundable, but your deposit may be used for a future litter when you are ready. The only way a deposit is truley forfeited is in the case of a no call/no show or backing out more than once.

    Refunds on puppies are not required, but we will always try to work with our families if something unexpected happens and you cannot keep your dog. If a puppy or dog needs to be rehomed, we will help find a new home, but refunds will not be given until the dog has been placed and is settled. Per our contract, any Effingham Retrievers dog that needs to be rehomed must be approved by us and placed with a new owner contract no matter who it is. This is only to ensure none of our puppies ever end up in a shelter or in unsafe or dangerous situations.

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  • 38
    Please Select
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    • Got it!
    • Got questions about these - please contact me.
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