Puppy Application

Full Name *

First Name Last Name

Age

E-mail *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number - Home *

Area Code Phone Number

Phone Number - Cell *

Area Code Phone Number

Do you live in a: *

Do you: *

Own Rent Live with Parents Other

Household Setting *

Rural Suburban Urban

Do you have a fenced yard? *

Yes No Partial

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? *

Yes No

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? *

Male Female No 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? *

Yes No

Will you crate train the puppy? *

Yes No

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

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

Yes No

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 *

Month Day Year Hour Minutes AM/PM Option

Your name *

Co-Applicant name (if applicable)