Upstate Revival Retrievers Puppy Application Form

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!
- Full Name*
  
  First NameLast Name
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Phone Number*
  Format: (000) 000-0000.
- E-mail*
  example@example.com
- Which is your preferred method of contact?*
- Age*
- Occupation*
- How did you hear about us?*
- FemaleMaleNo 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?*
- Where will the puppy spend time while you work or are away from home?*
- Are you prepared for the puppy stage and do you understand the 10+ year commitment that comes with a Golden Retriever?*
- Kibble/dry foodRawCombinationUnsure
- HouseApartmentCondo/townhomeOther (specify)
- Do you own or rent your home?*
- Do you agree If you rent, will you submit proof of permission from your housing unit?*
- Do you have access to a fenced in yard? If not, where do you plan to exercise your puppy/dog?*
- Who will be the caregiver/owner of the puppy?*
  Please note caregiver/owner must match contract
- Have you ever owned a dog before?*
- Have you ever owned a Golden Retriever before?*
- Please list all other pets in home and if they are spayed/neutered*
  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?*
- Are you currently in contact with other breeders or on another breeder’s waitlist?*
- Do you agree to review and sign our contract if approved for a puppy?*
- YesNo
- YesNo
- Lilly x Baker- late July 2026Sunny x Maui- late July- early August 2026Cannoli x Stitch- November 2026Maui x Baker- Fall/Winter 2026Interested in future littersStarted dog/puppy
- Please specify the type of personality you are looking for.*
- 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. *
- Do you agree to keep in contact with the breeder? *
- YesNo
- Do you have any questions or is there anything you’d like us to know about you?
- Should be Empty: