This is the Gold'C'ker Golden Retriever Puppy Adoption Application Form; it is NOT an agreement for us to place a dog or puppy with you. Expect more questions to follow, including a phone interview, family meeting, references and potentially a home check. There are no right or wrong answers, we rely on your honesty to help us provide further education and support. We use this form to help us match a Golden Retriever to your lifestyle, your situation and your expectations which gives you and your Golden Retriever the best chance at success.

Name: Email:

Street:

City/Town:

Mailing Address

Postal Code/ ZIP:Province /State:

Cellular Phone: Business Phone:

1. How did you hear about Gold'C'ker Golden Retrievers?

2. Which sex do you prefer? Why?

5. Are you looking for a puppy or older dog?

8. Why are you interested in adopting a Golden Retriever? Choose as many as apply and rank your importance: (H=High, M=Medium, L=Low, N=No Interest)

- House Pet

- Conformation Showing

- Competition Obedience

- Hunting/Working Tests

- Tracking / SAR - As a Gift

- Protection / Guard Dog

- Therapy / Assistance Dog

- Breeding

- Agility

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3. What are your feelings on spaying/neutering?

4. Do you have a preference of coat color? Why?

6. If your first choice is not available, would you be willing to consider other options or would you wait for another litter?

7. Please list the most important considerations you are looking for? (i.e. size, energy level, breeder support, structure, etc.

10. Describe the characteristics of the ideal Golden to match your family's lifestyle and meet your purposes (i.e. activity level, size, personality type, etc).

9. How long have you been considering adopting a Golden Retriever?

11. What qualities of the breed make you most apprehensive?

Home Phone:Enter phone numbers without dashes Enter phone numbers without dashes Enter phone numbers without dashes

13. Where have your previous dogs come from?

12. Would this be your first Golden? First dog? If not, please describe other dogs you have had or currently have.

14. What other animals are currently part of your family? Are they spayed or neutered? How will you train your Golden to co-exist with them?

19. Describe you and your family members occupation(s) and work hours. How many hours per day will the puppy be home alone?

18. Where will the puppy be kept during the day? During the night?

17. Have you ever had to give a dog to someone else or return it to the breeder? If so, why?

16. Have you ever had to give a dog to a shelter or rescue program? If so, why?

15. Have you ever had to euthanize a dog? If so, why?

20. Do you own your home or rent? How long have you lived at this residence?

27. Please describe your yard. What type of fence (material, how high)? Do you have a dog run?

26. Does anyone in your household smoke?

25. Does anyone in your household have allergies? Please describe.

24. What kind of floor surfaces will the dog be on in the house?

23. Your home setting (choose one):

22. Describe your home location (choose one):

21. If you rent, do you have your landlord's permission to have a dog? If yes, please provide landlord's name and phone number:

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29. How many hours a day with your dog be kept outside?

28. If you have no fence or dog run, what are your plans for controlling your dog outside of your house.

40. Please list any dog clubs or organizations of which you are a member.

39. Are you interested in having someone else show your dog at a CKC or AKC event?

38. Have you had any experience with AKC or CKC events? If so, please describe. If not, please indicate any events you would be interested in learning how to compete.

37. Briefly describe your experience in training a dog. Include both methods and results. If you have not had any experience, how do you plan on learning?

36. Which member of the household will have the primary responsibility for taking care of the dog?

35. What activities do you and your family like to do?

34. Do you have any children? If so, what are their ages and history with dogs? Do you plan on future children?

33. Who will provide care when you must take a trip without your dog? How often and where do you typically vacation?

32. What type of vehicle do you own? How and where will your dog ride in your vehicle?

31. What are your thoughts about crate training?

30. How do you plan on exercising your Golden Retriever? What type of exercise and how often?

41. Would you consider joining Golden Retriever Clubs? If not, why?

42. Have you ever bred a dog in the past? If yes, please describe (how long ago, situation, etc).

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43. Are you interested in breeding your Golden? If yes, what would be your reason for breeding?

44. Do you understand what a limited registration utilizing a non-breeding or co-ownership contract is?

45. What are your expectations of a breeder?

48. What do you plan on feeding your dog?

46. Would you be willing to let us visit your home?

49. Do you plan to vaccinate your dog?

53. How do you feel about maintaining contact with Gold'C'ker Golden Retrievers and providing updates on your dog for his or her entire life?

52. Please provide us with your Veterinarian contact information.

51. Please provide us with two references (name, phone number and email) of people who know and have known you and your dogs/pets long term.

50. Under what circumstances would you not be able to keep this dog?

54. Please let us know any other information you wish us to consider in placing one of our Gold'C'ker Golden Retrievers with you - here is your chance to personalize this application.

All of the information I have given above is true and complete. I understand that submission of this application does not guarantee that I will be offered a

dog or puppy for purchase, and that Gold'C'ker Golden Retrievers are under no obligation to provide me with a puppy. This application becomes part of

our contract.

Photos of your home, yard and family members (animals included) are appreciated as they assist us in getting to know you better and making a selection

for you. Photos may be emailed. Thank you for your interest in Goldcker Golden Retrievers. Please remember that we want to make the best fit for our

Golden Retrievers and your family. Please do not hesitate to contact us with any questions.

Upon further interview and agreement to requirements and suitability of a Gold'C'ker Golden Retriever, you will be asked for a deposit to confirm your

commitment.

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47. Pets are a long term investment and commitment of time and money. Vet expenses can suddenly run many thousands of dollars. How are you planning for this? Are you financially prepared to provide veterinary care, proper diet, proper training, proper grooming and exercise of your new Golden for his or her entire life span?

** Please Note: -This form is a dynamic web document and is not formatted or available to print. - Security level is for submission only, exclusive for Administrative purposes.