Element Belgians Puppy Questionaire
Thank you for your interest in a Element puppy. Below, I have attached an in-depth puppy application questionnaire for you to fill out, to further assist my understanding in what you may be interested in purchasing from me. Once your application has been processed, a phone interview will be set up.
Questionnaire:
Your assistance in completing this questionnaire will help us in placing the right puppy in your home. These questions are not meant to be judgmental in any way, so please feel free to be candid in your responses.
Disclaimer:
If you are inquiring about a pet/ companion puppy , they are sold with AKC Limited Registration along with spay/neuter contracts. This means that the dog is eligible to be registered, however, none of the offspring are eligible for registration. In other words, this dog is NOT to be bred. A dog with Limited Registration, as well as a spayed/neutered dog can compete in all AKC events except in the Conformation ring.
Date:
/
Month
/
Day
Year
Date
Name:
First Name
Last Name
Email:
example@example.com
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation:
Spouses' Name & Occupation:
Number of Family Members:
Ages of Children:
1. How did you hear about Element Belgians, and why are you choosing us as your breeder?
2. Why have you decided to purchase a Belgian Malinois?
3. Which gender do you prefer?
Male
Female
Either
4. If your first choice (Male or Female) is not available would you consider taking a puppy of the opposite sex or would you want to wait for another litter?
Yes
No
5. What is the most important reason in your purchasing process, of a Belgian Malinois? Please check all that apply:
Family Companion
Service Animal
Conformation
Performance
Breeding
Therapy Dog
Herding
Personal Protection
6. Have you completed any AKC, CKC (Canadian), FCI, etc. titles on any of your dogs?
Yes
No
7. Would you consider an adult Malinois, if available?
Yes
No
8. Do you, currently, own other pets?
Yes
No
If yes, please describe breed, spayed/neutered, and ages of each:
9. What type of personality are you looking for? Please check all that apply:
Reserved
Outgoing
10. Is your yard completely fenced?
Yes
No
11. Where will the Puppy be accommodated during the day?
12. Are you willing to crate train the puppy?
Yes
No
13. Will someone be home with the puppy during the day?
Yes
No
Other
14. When this puppy is purchased as a Pet/family companion, do you agree to have both males and females spayed or neutered by 2 years of age and submit a Proof as such for our records?
Yes
No
15. Are you willing to take your puppy to ‘Puppy Kindergarten’/ socialization and basic obedience classes to insure that you have a well-mannered, enjoyable companion?
Yes
No
16. If yes, who in your home, will do the training?
Yes
No
17. Do you have a veterinarian?
Yes
No
Please provide your Veterinarian Clinic’s name, address & contact information:
18. Do you have a trainer and or training facility? If so please list
19. Have you ever given a dog away or taken one to a pound or shelter? If so, what were the circumstances?
20. Have you ever owned a Malinois before?
Yes
No
If so, what happened to that/those dog(s) and who are their breeders?
21. Please specify your living situation:
I am a homeowner and own my house.
I am renting from a landlord.
I am living in parents’ and/or grandparents’ home.
I am living with a roommate and or roommates.
Other
22. Why do you think you would make a great home for my puppy?
23. Please add any additional information that you’d like me to know about you.
Submit
Should be Empty: