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92 Bedford Road Merrimack, NH 03054 (603) 493-8046 Phone (603) 424-8915 Fax. Puppy Application. Tell me about Yourself Name: _________________________________________________

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
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92 Bedford Road Merrimack, NH 03054 (603) 493-8046 Phone (603) 424-8915 Fax

Puppy Application

Tell me about Yourself

Name: _________________________________________________

Address: _________________________________________________


Home Phone: _________________________ Work Phone / Cell Phone: ________________________

E-mail Address: _____________________________________________________________________

Occupation: _____________________________________________________________________

Hours Worked: _____________________________________________________________________

Tell me about where you live

Type of Dwelling: House Condo Apartment Mobile Home

How long have you lived at this address? _____________________________________________

If renting, does your landlord allow dogs? _____________________________________________

Do you have a fenced-in yard? If so, how large: _____________________________________________

If not, will you be willing to install one prior to bringing your new puppy home? ______________

Are there any other pets living in the home? ____________________

If so, name the type and age of the pet: ____________________________________________________________

Are there any children living in the house? If so, what are their ages:



Choosing a puppy

Referred by: _____________________________________________________________________

Why are you choosing our little goldens? _________________________________________________________

Which litter are you interested in? _________________________________________________________

Do you prefer a male or female? Please explain why: _________________________________________________


If your first choice is not available, would you be willing to take one of the opposite sex? _____________________


Are you ready for a dog?

Who will be the primary caregiver: ________________________________________________________

Why have you chosen this breed? ________________________________________________________

Have you ever owned a dog? If so, when and what breed: ___________________________________

Are you aware of the pros and cons of this breed? __________________________________________

Do you intend to crate-train your dog? _______________________________________________

Have you ever house-trained a dog before? _______________________________________________

What are you looking for in a puppy/dog? _______________________________________________

Does anyone in the home have any allergies to dogs? If so, how severe are they: __________________


Who will groom your new puppy/dog and how often? _______________________________________

Are you aware of the expenses of having a dog: food, vet bills, training, etc? _____________________

Do you agree to feed this dog premium dog food for its optimal health? _________________________

Will you provide this dog with the best medical care when needed? ____________________________

Do you agree to have your dog spayed or neutered within the first 6 months? _____________________

What Veterinarian will you be using? Please provide the name, address and phone #:


Some other questions for you

Where will the puppy be kept during the night? ____________________________________________

When not at home, where will the puppy be kept? __________________________________________

Is anyone home during the day? ________________________________________________________

On average, how many hours will the puppy be left alone: ___________________________________

Will there be anyone available to feed and exercise the puppy during the day? ___________________

What do you expect the activity level of this breed to be:

Very High High Moderate Below Average

When your dog is outside, how will he be confined? ________________________________________

Have you ever returned a pet to the breeder? If so, what were the circumstances? __________________________


Have you ever taken a pet to a pound or shelter? If so, what were the circumstances? _______________________


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Are you interested in showing the dog in the conformation ring? ___________________________

Are you interested in competition events such as obedience, agility, hunting, etc? __________

Do you intend to breed the dog? ___________________________

Do you understand the difference between “Limited Registration” and “Full Registration”? ________

Are there any major changes in your life in the near future such as divorce, moving, new job,

new baby, or other such situations? If so, explain: ___________________________________________________


Do you agree to NEVER leave this dog outside in extreme weather? _________________________

Do you agree NEVER to chain this dog to any stationary object, such as post, tree or leave it in the garage? ________________________________________

Do you agree to NEVER let this dog run off leash in an unfenced, unsecured area? ____________

Do you agree to use only positive re-enforcement training with this dog? ____________________

Do you agree to NEVER use electronic collars on this dog? ______________________________

Do you plan to title this dog in any way, and if so, for what? _____________________________

In the event that you are unable to keep this dog, would to give the breeder first option to take it back? _________________________

Please provide three references that we may contact; their names, phone numbers and/or e-mail address: ________________________________________________________________________________



All of our pet/companion puppies are sold with AKC Limited Registration and spay/neuter contracts. This means that the dog is registered with AKC however, none of the offspring are eligible for registration. A dog with a Limited Registration as well as a spayed or neutered dog can compete in all AKC events except Conformation (breed ring).

I swear that by submitting this application that the content is the truth and to the best of my knowledge. I also understand that by submitting this application, it does not guarantee me a puppy, all potential buyers must also be interviewed by the breeder prior to approval.

Signature of Applicant: ____________________________________ Date: _____________________

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