Name _____________________________________________ Phone # _________________________

Address ____________________________________________ Email Address _____________________

City ____________________________________       State ______________     Zip Code ______________

How and when did you hear about Flat-Coated Retrievers?


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Puppy Preference:   Male Female

Why are you interested in obtaining a Flat-Coated Retriever?     
     
Conformation Field Work Obedience  Tracking      Agility    Therapy Dog Int’l                Companion/Pet

What qualities do you like in a Flat-Coated Retriever breed?


_______________________________________________________________________________________

What don’t you want to find in a Flat-Coated Retriever?


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Is this your first Flat-Coated Retriever?  Yes             No  

Have you previously owned a dog?
Yes No       When: ________________    Breed: ____________________

Cause of Death ______________________        Age at time of death: __________________

Other animals at home now: 
Yes                No                What kind: ____________________________

Are you willing to spay/neuter this dog? 
Yes                No

Where will dog stay during the day? __________________________________________________________

Family Data:
Married         Single        Divorced ______     # of Children ______    Ages _______

Your occupation(s) ___________________________________________________________________

Do you live in: 
Urban                                  Suburban     
Rural                                   Own              Rent
Is your property fenced in?  Yes              No

Please use reverse side of this questionnaire to add any further information you wish me to know in considering placing  a Flat-Coated Retriever puppy with you.  I’d appreciate it if you gave some insight into the expectations you may have for this new addition to your family.