Puppy Questionnaire
Your Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
What age dog are you interested in obtaining?
Puppy
Juvenile
Adult
I'm not sure
Are you wanting a Male or Female puppy?
Male
Female
Either
I can't decide
What are your preferences? (We cannot guarantee we will have one in our litters, please understand and be open minded when applying for a puppy)
Full mask
Half mask
No mask
Either
Do you have a color preference?
Please describe any physical attributes that are of particular importance to you in the puppy/dog you are seeking at this time?
Have you ever owned a Australian Cattle Dog
Yes I have owned, and currently do not
Yes I have owned, currently own
No I haven't, but have handled them before
Never
For each dog you currently own, please list the following: Name – Breed or mix – Sex – Age – Is pet spayed or neutered?
Do you have other pets? If yes, please list.
What activities are you and your puppy/dog going to be involved in?
Showing
Agility
Herding
Service Work
Other
If "Other" above, please tell us more about the plans you have for your puppy/dog:
Tell us a little about yourself (occupation, family, hobbies)
Are you interested in Full/Breeding rights or Limited/Pet only rights?
*
Full/Breeding rights
Limited/Pet rights
Co-own
Are you willing to Co-own a puppy/dog? For co-ownership agreements, female puppies are often placed with return puppies to back to us -out of approved studs, and male puppies are often placed with return stud services to us
Yes, I am open to Co-ownership
Yes, but not ideal
No, I would like full/breeding rights
No, I would like limited/pet rights
Do you understand the meaning of Limited/Pet and Full/Breeding rights?
Yes
No
Are you willing to Spay/Neuter?
Yes
No
Do you understand our puppies will cost $1000-$2500 once you're approved?
*
Yes
Do you understand you will be required to sign contract of terms for Spaying/Neuter or Show/Breeding rights?
*
Yes
Which are you looking for? (Please note: type of Registry will be listed under each individual dog or litter)
AKC (American Kennel Club)
ASDR (American Stock Dog Registry)
Un-Registered
Any
How would you describe your household activity level?
Very quiet
Rather easygoing
Usually something going on
Lots of activity
Where will the puppy/dog live? Where will your puppy/dog stay during the day? Where during the night?
Have you crate trained a puppy before?
Yes
No
Are you willing to take the puppy to puppy socialization class?
Yes
No
Tell us about where you live. Are you in a city or a more rural area?
Do you own or rent your home?
Own
Rent
Do you live in:
Apartment
House
Mobile home
Condo
Other
If other, please specify
If you rent, a signed letter from your landlord stating that dogs are permitted on their property must be received before a puppy is placed with you. The breeder reserves the right to contact the landlord before placing any puppy. Please provide your landlord's contact information:
Do you have a fenced in yard?
Yes, fully fenced
Yes, partially fenced
Not fenced, but kennel setup
Not fenced
Are you acquiring a puppy/dog for yourself or for someone else? If for someone else, are they aware of your intentions, or is the dog to be a suprise?
How many members are in your family? Names and ages, relations? Any children?
As the breeder, it is important for me to keep track of all my dogs that have been placed. Are you willing to work with us to stay in contact regarding the development of your puppy?
Yes, I'm willing to stay in contact and update breeder
No, I do not want to keep in contact
Have you ever given a dog away and why?
If you were to move, what would happen to your puppy/dog?
In the event of emergency (e.g., hospitalization, natural disaster, etc), who would take care of your dog?
Have you or anyone in your household ever been charged with animal cruelty or had any animal taken away from you or any member or your household for suspicion of animal cruelty? If yes, please explain.
Are you applying for a specific planned breeding or puppy/dog? If so, please list which one below:
What timeframe are you looking to add a puppy/dog to your home?
1-3 months
3-6 months
6-12 months
1-3 years
Do you have a veterinarian, please provide address, and contact information below
Do you have any questions for us or any other relevant information you would like to provide?
Please verify that you are human.
*
Submit
Should be Empty: