Puppy Request Form

* First Name

* Last Name

* Street Address

Address Line 2

* City

* State

* Zip Code

* Phone Number

* Email Address

Date

What breed are you interested in?

Golden Retriever

English Setter

Need help deciding.

What sex would you prefer?

Male

Female

No preference

Would like assistance in choosing

Occupation

How did you hear about us?

Are there any children in your household?

I do not have any children

I have children under the age of 3

I have children between the ages of 3 and 10

I have children over the age of 10

I have frequent child visitors in my house

When do the adults in the household work? Will there be somone to let the puppy outside? Please check all that apply.

All adults work full-time outside the home.

An adult would be home with a puppy most of the time

I am able to take a puppy/dog to work with me

Do you have a fenced in yard? Please check all that apply.

I have a home with a fenced yard

I do not have a fenced in yard yet, however plan to put up a fence prior to purchasing a puppy

I live in an apartment and will walk the dog

I have a fenced kennel area to exercise the dog

I have a home without a fenced yard and I will walk the dog

What is your history with dogs? Please check all that apply.

I have never owned a dog

I currently own a dog(s)

I have owned a dog(s) in the past

I own/have owned a English Setter

I own/have owned a Golden Retriever

Please list all current pets, and their ages.

Please check the following activities you plan to do with your puppy.

What activity level are you expecting in your new dog?

Very quiet, laid-back and well behaved

Moderately active, playful

Active dog that can keep up with lots of physical activities

If all members of the household are going to be away from home over night, or for a long period of time who will care for the dog? Please check all that apply

A family member/friend/pet sitter would care for the dog at home

The dog would board at the veterinarians or a boarding kennel

The dog will go with the owner(s) when traveling

A friend/neighbor/family member would keep the dog

The dog could stay alone in the yard/kennel and adequate food and water could be left for the time the owner is away

Are you aware that both English Setters and Goldens require regular grooming and both, especially goldens, shed year round? Please select all of the following that apply:

I am aware that English Setters and/or Golden Retrievers require regular grooming, bathing and brushing. I am also aware that both breeds shed, especially Golden Retrievers.

I will take my dog to be groomed by a professional

I will be doing all the grooming, bathing and brushing

I am interested in learning how to groom my dog.

Do you understand and accept the financial responsibility of providing a dog satisfactory health care? Please select all of the following that apply.

I understand the importance of feeding my dog quality dog food.

I understand the importance of providing my dog regular vet year (at least one visit per year)

I am willing to provide my dog/puppy with flea/tick preventative

I understand and am willing to provide my puppy with the vaccinations suggested by my breeder and my vet

What color golden would you prefer? Check all that apply

If you are interested in an English Setter, what color would you prefer?

Blue

Orange

Tri

No preference

Do you understand the difference between a limited and full registration? All "Pet Quality" puppies are sold with a limited AKC registration, which means that the male/female must be spayed or neutered. Proof of the spay/neuter must be provided to the breeder in the requested time. All "Show Quality" puppies are sold with a full registration, which means that they are able to use the dog for breeding purposes.

I am interested in purchasing a pet quality puppy and understand that they are sold with a limited registration.

I am interested in purchasing a show quality puppy and understand that they are sold with a full registration.

If you purchase a Baybreez puppy/dog, will you agree to notify the breeder and return the dog if you are no longer able to provide the dog with an appropriate home, and will you agree to never give away, trade, surrender to a shelter, abandon or re-sell the purchased animal without the breeder's consent?

Yes

No

Which litter are you interested in?

Bay Breez Litter (English Setter) - Spring 2011

Chloe Litter - (Golden Retriever) Homes in December

Adult Dog - Golden

Adult Dog - Setter

Other

Is there anything else you would like to let us know that will help us place a puppy with you?

* Indicates Response Required