Upstate Revival Retrievers Puppy Application Form
Thank you for your interest in Upstate Revival Retrievers. Please fill out this application to be considered for one of our puppies. This application does not guarantee you a puppy but is for us to get to know you and your lifestyle so that we can understand what/who will fit you best. Please fill out the entire application; incomplete applications will not be considered. Your application will remain on file for 5 days without a deposit. If no deposit is placed, your application will be removed and you will need to resubmit your application when you are ready. Please inquire about pricing if you have not done so. We will accept deposits only after being contacted via your preferred contact method. Thank you!
General Information
Full Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Format: (000) 000-0000.
E-mail
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example@example.com
Which is your preferred method of contact?
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Age
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Occupation
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How did you hear about us?
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Please Select
Social media
AKC marketplace
Good Dog
Other
Gender preference?
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Female
Male
No preference
How many adults and children live in your home? Please specify ages of children
*
What type of schedule do you plan to have for your puppy?
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Where will the puppy spend time while you work or are away from home?
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Are you prepared for the puppy stage and do you understand the 10+ year commitment that comes with a Golden Retriever?
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What type of diet do you plan on using for a puppy?
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Kibble/dry food
Raw
Combination
Unsure
Home Life
What type of home do you live in?
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House
Apartment
Condo/townhome
Other (specify)
Do you own or rent your home?
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Do you agree If you rent, will you submit proof of permission from your housing unit?
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Do you have access to a fenced in yard? If not, where do you plan to exercise your puppy/dog?
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Puppy Info
Who will be the caregiver/owner of the puppy?
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Please note caregiver/owner must match contract
Have you ever owned a dog before?
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Have you ever owned a Golden Retriever before?
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Please list all other pets in home and if they are spayed/neutered
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Please note we do not place puppies in homes where opposite gender dogs are not altered unless discussed with us
Who is your current veterinarian? If you do not have one, who do you plan to use?
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Details
Are you currently in contact with other breeders or on another breeder’s waitlist?
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Do you agree to review and sign our contract if approved for a puppy?
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We firmly believe in matching puppies to families. They will be temperament tested and matched according to what type of personality/energy levels will suite your needs the best. We will do our best to keep physical preferences in mind but we make no guarantees on adult color. Please make sure you’re as descriptive as possible to ensure we make the best decision for you. Do you understand that we will ultimately have final say in which puppy will best fit your needs?
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Do you understand to notify us immediately if you are in need of rehoming or returning your puppy/dog? The contract will require the puppy/dog to return to us
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Yes
No
Do you understand that puppies are sold with NO breeding rights unless agreed upon? Every puppy will go home with limited registration deeming them unable to produce puppies or participate in conformation.
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Yes
No
Which litter are you interested in? Please note go home date is an estimate
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Lilly x Baker- late July 2026
Sunny x Maui- mid August 2026
Cannoli x Stitch- November 2026
Maui x Baker- Winter 2026/early 2027
Interested in future litters
Started dog/puppy
Please specify the type of personality you are looking for. Dominant, submissive, confident, independent, people oriented, toy drive, food drive, etc.
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Upon approval, you are welcome to submit a deposit once contacted. Do you understand that deposits are non-refundable? You will have 3 opportunities to move your deposit to another litter before forfeiting your deposit.
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Do you agree to keep in contact with the breeder?
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We do not allow in person visitation for safety purposes. We are more than happy to FaceTime, video call, and update frequently as the litter grows. Do you understand that we are unable to accommodate in person visits with puppies?
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Yes
No
Do you have any questions or is there anything you’d like us to know about you?
Submit
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