New Puppy Application Form
Applicant Details:
Which breed are you interested in?
Golden Retriever
Chesapeake Bay Retriever
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
example@example.com
How did you hear about us?
*
Please Select
Online Search
Social Media
Friends
AKC
Good Dog
Other
Please Specify
*
Occupation
Do you prefer Male or Female
Male
Female
Either
What type of registrations are you interested in?
Limited Registration
Full Registration / Co-own
Does everyone in your family want a new puppy?
Yes
No
Do you have children?
Yes
No
If yes, please provide ages below.
Do you currently own a dog?
Yes
No
If yes, please provide breed and age
Do you have other pets?
Yes
No
If yes, please provide types
Do you have a fenced in yard?
Yes
No
Will the puppy be home alone all day?
Yes
No
Do you have the time and energy to care for a young puppy?
Yes
No
Are you willing and able to accept that responsibility?
Yes
No
Are you committed to caring for a puppy for it's lifetime?
Yes
No
Do you have the means to budget for a new puppy? Including but not limited to Veterinary care, shots, monthly heartworm medication, annual vaccinations, crate, food, toys, grooming products, etc.?
Yes
No
Will you be attending any training classes or hiring a professional trainer?
Yes
No
Please list the name and phone of the veterinarian or clinic you will be using for the puppy.
Have you used this vet before?
Yes
No
May we contact them for a reference?
Yes
No
At any point in time should you determine you are no longer able to care for the dog, we request that dog be returned to us. Are you willing to agree to this?
Yes
No
Why have you chosen this breed?
One Reference
Non Family Member - Please provide name and phone number
Signature
Please submit application payment of $50
application fee is non refundable and will be applied to final cost of a puppy
Continue
Continue
Should be Empty: