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.

Do you currently own other pets?  Yes No
If so, please describe (species, breed if a dog, and 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? Yes No

Have you visited the Golden Retriever Club of Canada website (www.GRCC.net) and/or have done other research on this breed? Yes No

Do all family members want a new puppy?  Yes No

Are there children in the family? Yes No

If so, please state their gender and ages

Do any family members have allergies to dog? Yes No

Are any family members afraid of dogs? Yes No
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…?  Yes No

If “yes”, please describe

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

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

Are there restrictions in your neighborhood regarding dog ownership? Yes No

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). House Crate in House Dog Run with 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”? Yes No
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). 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? Yes No

Do you padlock your gates? Yes No

Do you have a chain-link kennel run?  Yes No
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? Yes No

Do you have a swimming pool? Yes No

If “yes”, is your pool fenced to prevent a puppy/dog from swimming unsupervised? Yes No

Do you plan travel with your dog? Yes No

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

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

If you have selected a preference, would you be willing to take a puppy of the opposite sex if your preference is not available? Yes No

Goldens live approximately 10 to 14 years.  Are you committed to care for this Golden Retriever’s needs throughout his/her lifetime? Yes No

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? Yes No
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? Yes No

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? Yes No
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? Yes No

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?  Yes No

Do you feel we can maintain a long-term relationship to discuss the health and welfare of your Golden Retriever? Yes No

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.