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Omaragold Golden
Potential Puppy Owner Questionnaire

Please fully complete this questionnaire and click the submit button below.
There is a section at the end of this questionnaire should you want to include any additional information.

This application is just a beginning step in the interview process.

All information will be confidential and used only by the Breeder/Owners of this litter.

Thank you for your cooperation and interest.

Please complete the entire form below.


First Name  
Last Name  
Postal/Zip Code  
Home Phone  


How did you learn about Omaragold Goldens?

Do you currently own other pets? 
If so, please describe (species, breed if a dog, and age)

If you do not currently have a dog, have you owned a dog(s) before?

If so, what breed(s)?

What happened to that/those dog(s). If they are deceased, include how/why they died and at what age ?

Why have you chosen a Golden Retriever to become a part of your family?

Are you familiar with the Golden Retriever’s grooming requirements, temperament,
nutritional needs, and activity level?

Have you visited the Golden Retriever Club of Canada website (www.GRCC.net) and/or have done other research on this breed?

Do all family members want a new puppy

Are there children in the family?

If so, please state their gender and ages

Do any family members have allergies to dog?

Are any family members afraid of dogs?
If so, please explain

Do you have any anticipated major life event changes such as a new baby, caring for an elderly or sick relative, etc…? 

If “yes”, please describe

Do you (own/rent/lease) your principle residence?

Do you live in a (house/apartment/condo)?

Are there restrictions in your neighborhood regarding dog ownership?

Where will your Golden Retriever be accommodated during the day (house/crate in the house/dog run with a dog house/yard with a dog house/other).
If “other”, please describe

Is someone home during the day, or able to get home to let the puppy out to “potty”?
If “no”, what arrangements will you be making for your new puppy?

What is the approximate number of hours your puppy will be alone?

Where will your Golden Retriever be housed at night? (house/crate in house/dog run with dog house/yard with dog house/other).
 If “other”, please describe

Do you have a securely fenced yard?

Do you padlock your gates?

Do you have a chain-link kennel run? 
If “yes”, what size

Please describe your yard size and fencing

If your yard is not fenced or you do not have a chain-link kennel run, would you be willing to have it installed before you bring home a new puppy?

Do you have a swimming pool?

If “yes”, is your pool fenced to prevent a puppy/dog from swimming unsupervised?

Do you plan travel with your dog?

If “no”, where will your dog stay during your vacations? (boarding kennel/veterinarian/stay with friends/other).
If “other”, please describe

What gender do you prefer?  (male/female/no preference)

If you have selected a preference, would you be willing to take a puppy of the opposite sex if your preference is not available?

Goldens live approximately 10 to 14 years.  Are you committed to care for this Golden Retriever’s needs throughout his/her lifetime?

Who will be the primary caretaker --feeding, training, exercising, socializing, and grooming-- for this golden?

Have you ever crate trained a puppy or a dog?
If “no”, please describe

What type of personality/activity level are you looking for in a golden?

Do you have any interest to train this puppy for future use in obedience, agility, tracking, field, or conformation shows for CKC titles?

Are you willing to spay your golden retriever by 12 month of age or neuter by 18 months of age and provide the breeder with a veterinarian certificate as proof of surgery?
If “no”, please explain why

Will you allow a home visit by the breeder or breeder’s representative prior to a puppy being placed in your home?

Please list the name, address, and phone number including area code, of the veterinarian/veterinary clinic that we may use as your reference.

If different from above, please advise the name, address, and phone number of the veterinarian/veterinary clinic you plan on using for your Golden Retriever.

Please list any references of someone involved in dog events that knows you?

Do you agree to return this Golden Retriever to the breeder in the event you are no longer able to care for the dog, regardless of age? 

Do you feel we can maintain a long-term relationship to discuss the health and welfare of your Golden Retriever?

Please include any comments that will help us place the right puppy with you.

By submitting this application, I am acknowledging that the information entered is true and correct.  I  understand that sending this application does not automatically entitle me to a dog.
I understand that this application is just a beginning step in the interview process.

Please review and then submit this completed questionnaire.  We will contact you via Email as soon as possible regarding the availability of our Omaragold puppies.



Email: Barbara Ann Savary
Ontario  K0A 2R0


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