NewPuppyHomeQuestionnaire

Name____________________________________________________e-mail_________________

Address____________________________City______________State____________Zip________

Home Phone _________________ Work Phone ________________ Cell Phone______________

I prefer to be called at: ______ Home   ______Work ______Cell

How did you hear about Heritage Rock Goldens? _________________________________________

Now that you know about us, what attracts you to our puppies? _______________________________
_________________________________________________________________________________

PREFERENCES
1. Puppy pick up is at 7 weeks old, shipping at 8 weeks old

2. I would like a   _____male    _____female    _____not sure    _____no preference

3. Understanding it is hard to determine the adult color of a golden while still a puppy, I would prefer a
__light golden __light to golden __golden __dark golden __no preference

4. Do you plan on breeding this dog? _______ yes   ________no   _______not sure

5. Do you plan to pick up puppy or do you need shipping arrangements made?_______________

6. If shipping or delivery, to what city and state? _______________________________________

HOUSING INFORMATION

1. Do you own or rent your home? ________
If you rent, do you have the landlord’s permission to keep a dog? ________
Would you mind if I contacted them to confirm this? ____ Their Name & phone number: ___________________

2. Do you have a secure yard / exercise area? __________
Please describe_____________________________________________________________
If not, how do you plan on handling your puppy’s potty needs?

HOUSEHOLD INFORMATION
1. How many adults in the household? ______   How many children? ______ Ages of children _____________

2. Occupation of adult #1_________________________________________________________
Occupation of adult #2_________________________________________________________
Occupation of adult #3_________________________________________________________

3. What is the relationship of the Adults in the household to each other? ______________________

HOUSEHOLD PET INFORMATION
1. Do you own other dogs? _____yes ______no
Please describe each one (breed & age)___________________________________________

2. Do you own cats? _______   Is yes, how many? _____________

3. Do you have other animals? ________ If yes, please describe__________________________

4. Have you ever owned a Golden before? ___________

5. Why did you choose this breed? _________________________________________________

6. What are your plans for this dog: Pet_____ Guard____ Hunting____ Show____ Other_______

7. How much time each day do you plan on spending with your puppy / dog _________________

8. Who will be the primary training / care giver for the puppy?_____________________________

9. How do you plan on house and obedience training your puppy? ________________________
___________________________________________________________________________

10. Will this puppy be primarily ______indoor ______outdoor
Where will this puppy sleep? ______________________________________________

11. Do you have a regular vet? _____yes ______no
If so, would you mind if I contacted him / her? _____yes _______no
There name:___________________________________
Phone #_______________________________________

12. Please list two personal references not related to you or living in the same dwelling with you:
Name_____________________ Phone# _________________________ Relationship to you__________________

Name_____________________ Phone# _________________________ Relationship to you__________________

If requesting breeding rights now or in the future, please list a third:
Name_____________________ Phone# _________________________ Relationship to you__________________

Thank you for investing this time in the search of your new family member.

Questionnaire for Prospective Puppy Homes

We believe that a puppy is a big responsibility.
This form is Required for reserving a Heritage Rock Puppy.
You may print and send this page in with your puppy deposit
($200 to get on our list for an unborn puppy or 1/2 of puppy fee for a puppy that is born)
OR
you may copy and paste this into an email to puregold@heritagerockgoldens.com