Puppy Application

Full Name*

First NameLast Name

Age

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number - Home*

Area CodePhone Number

Phone Number - Cell*

Area CodePhone Number

Do you live in a:*

Do you:*

OwnRentLive with ParentsOther

Household Setting*

RuralSuburbanUrban

Do you have a fenced yard?*

YesNoPartial

If fenced, please give details on height, approx. size & are gates secure?*

Please List all People Living in the Household (Include Name, Relationship, Gender and Age)*

Do you work full-time?*

Does Anyone in your Household have Allergies to Animals?*

YesNo

Please List any Pets you have Living or Deceased (Please include Name, Breed, Age, Sex, UTD Vaccines, Heartworm, Living/Deceased)*

Have you ever owned a Golden before?*

Do you have a preference in gender of puppy?*

MaleFemaleNo Preference

Are you aware of the grooming and exercise requirements of the breed?*

We cannot guarantee a puppy to be housebroken, are you equipped to train with love and patience?*

YesNo

Will you crate train the puppy?*

YesNo

How many hours in a day would the puppy be left alone?*

Are you willing to enroll in puppy kindergarten or obedience classes?*

YesNo

Have you ever shown a dog in AKC Events? Explain.

What goals will you have for this puppy?*

Enter the message as it's shown*

I understand that applying for a puppy does not ensure approval- this is the first step. We will contact you and set up a time for an in-person or phone interview.

I understand that all pet puppies from Aquinna Goldens are sold on a spay/neuter contract and cannot be bred.

I certify that all information on this application is truthful and correct

Date*

MonthDayYearHourMinutesAM/PM Option

Your name*

Co-Applicant name (if applicable)