Puppy Application

SIRE: BIS BISS GCH Am/Can Ch. Venture’s Boys N Toys SDHF, BISS AKC # SR42759001 

DAM: Grand Champion Harborview Sweeter Than ‘Shine At PoeticGold CGC  AKC# SR66031009

Litter Theme: “Popular Songs”

Price 2000.00$; nonrefundable deposit 300$

Potential Puppy Owner Questionnaire

All information is kept confidential and used only by the Breeders/Owners of the litter.  This questionnaire helps us match the right puppy with the right owner.  If you feel that any additional information would be helpful, please add it to the bottom of the questionnaire.


Name:  _____________________________________________________________________________

Address:  ___________________________________________________________________________

City:  ____________________________  State:  _____________  Zip Code:  ____________________

Home phone:  ________________________  Cell phone:  ___________________________________

e-mail:  _____________________________________________________________________________

Web URL:  __________________________________________________________________________

Your occupation:  ____________________________________________________________________

Spouse’s occupation:  _________________________________________________________________


        1.  How did you learn about PoeticGold ? ______________________________________________________

        2.  Why have you decided to purchase a Golden Retriever puppy?___________________________________



        3.  Do you prefer a male or female?  _____________________________________________________________

       4.  For what purposes are you purchasing a Golden Retriever puppy?  Show, Obedience, Agility, Field Work, Therapy Dog, SAR, Pet? _______________________________



       5.  Are there children in the family?  _____________________________________________________________

       6.  If so, what are the ages of your children?  _____________________________________________________

       7.  Do all family members want a new puppy?  ____________________________________________________


8.  Do you own or rent your principle residence?  __________________________________________________

9.  What type of housing and location do you have?  ________________________________________________

Examples:  Farm/house    Town/apartment

10.  Where will the puppy be accommodated during the day and the evening?

a.  Day  _________________________________________________________________________________

b.  Evening  _____________________________________________________________________________

   11.  Is there someone home during the day, or able to get home to “potty” the puppy? ___________________

a.  If no, what kind of arrangements will you be making for your new puppy?  _____________________


    12.  Do you have other pets?  _____________________________________________________________________

If so, please describe:  (breed, type, age etc.)  ___________________________________________________


13.  Are you willing to take this dog to obedience classes or puppy kindergarten so that he/she will become an enjoyable companion and a good canine citizen? ___________________________________________ 

14.  Have you ever owned a puppy?  _______________________________________________________________

15.  Did you  crate train the puppy or dog?  ____________________________________________________

If no, please describe why.  _________________________________________________________________

16.  Have you ever completed an AKC title?  ______  If yes, congratulations and describe?   ________________


17.  What type of personality are you looking for in your puppy?  ______________________________________

18.  What are your plans for this puppy? ___________________________________________________________


19.  If you ARE considering breeding this dog, are you prepared to obtain all of the following: Yes  or no?

a.  OFA Hip and elbow clearances _______

b.  CERF Eye clearances yearly _______

c.  Heart Clearance by a board certified cardiologist ______

20.  Are you willing to spay/neuter this dog if sold as a pet?  _________________________________________

21.  Please include anything else that will help us place the right puppy with you. ________________________



22.  Please name TWO persons that we could contact for references.  Please include one being the name of the veterinary clinic that knows you.  If this is your first pet, please give TWO references PLUS the name of the vet that you plan on taking your puppy to for its health care.

       List Name(s)      Phone Number(s) and if possible, e-mail(s)




I understand that sending this application does not automatically entitle me to a dog.  I understand that this application is just a beginning step in the interview process for a puppy.


Signed ___________________________

Please review, sign and return to: Date ____________________________


Jill Simmons 7 Trillium Lane, Falmouth, Maine 04105