Adoption Questionnaire Name * First Last * Last Email * Home Phone format: 207-111-2222 Mobile Phone format: 207-111-2222 Address * Address Line 2 City * State * AL AK AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code * Occupation * How did you hear about us? * Why do you want a Golden Retriever? * Do You Prefer: * Male Female No Preference Why? For what purpose are you purchasing a golden? * (pet, show, obedience, field, breeding, etc.) Do all family members want a new puppy? * Yes No If you have children, please list ages. Will this be your first dog? * Yes No Do you currently own a dog? * Yes No Age and Breed of current dog Do you have other pets? * Yes No List current other pets. Does your home have a fenced yard? * Yes No Where will your puppy be kept during the day? * Where will the puppy sleep at night? * Do you plan to crate train this puppy? * Yes No Are you planning on taking this puppy to obedience classes so he will become a treasured companion and a canine good citizen? * Yes No What training facility do you plan on using? What is the name of the veterinarian and 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 Please tell us a little bit about what you are looking for in a Golden Retriever and what type of activities you would likely be pursuing (such as a couch potato, jogging companion, a buddy for the kids, etc). reCAPTCHA If you are human, leave this field blank.