Puppy Application - Sierra Golden Retrievers

You can either fill our the form below, or download the Puppy Application, fill it out and email it to gregersen@ubtanet.com.

Your Name

Occupation

Address

How long at this address

Daytime Phone:

Nighttime Phone:

Best time to call:

Email address::

Family & Housing

How many adults are there in your family (their relationship to you)?

How many children (ages)?

What type of home do you live in single family, townhome, apartment, farm, etc.?

What type of yard does your living situation have? (fenced yard, dog park, etc.) describe

If you rent, please give the rules governing pets and the landlord’s name and number:

Please describe your household:

Does anyone in the family have a known allergy to dogs?

Is everyone in agreement with the decision to purchase a dog?

Do you have time to provide adequate love and attention?

Other Pets

What other pets do you have (specify type and age)?

Have you ever lost a pet to an accident?

Are these pets up to date on vaccines?

Are these pets spayed/neutered? If not..why?

Have you ever surrendered a pet? If so, why?

Have you ever had a pet euthanized? If so, why?

How do you discipline your pets and why?

Veterinarian

Do you have a regular veterinarian?

Veterinarian’s name:

Clinic Name:

Clinic Address:

Clinic Phone:

About the Dog You Wish to Adopt

What is your idea of an ideal dog and why?

Desired Color:

Desired Size:

Desired Gender:

Where will the dog spend the day? ( describe )

Where will the dog spend the night? ( describe )

Number of hours (average) dog will spend alone per day?

Who will have primary responsibility for this dog's daily care?

Who will have financial responsibility for this dog?

Do you agree to provide regular health care by a Licensed Veterinarian?

Do you agree to keep the dog as an indoor dog?

Personal References

Please list someone who is familiar with both you and your pets.

Name 1

Phone

Address:

Relationship (relative, neighbor, friend, etc.):

Name 2

Phone

Address:

Relationship (relative, neighbor, friend, etc.):

All of the information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian.

Signature

Date: