Name(Primary):

Name(Secondary):

Street:

City, Province & Postal Code:

    

Home Phone:

     Cell Phone:      

Work Phone:

     Other:  

Email:

 

 
 

Employer (Primary): 

 

Occupation: 

 

Average hours worked weekly: 

 

Number of adults living in household: 

 

Hours adults are home daily (including yourself): 

 

Number of children living in your household:    Ages: 

 

What type of area do you live in?  City   Suburban   Country

 

What type of housing:  Apt.   Condo   Duplex   House   Other
(please explain, how long you have lived here, etc.) 

 

If you rent or lease, do you have permission from your landlord to own a dog?
Yes     No

(Name and Phone number of your landlord) 

If less than two years, please list your previous address:

 

What breed of dog have you previously owned and what happened to them?

Were they spayed/neutered?  Yes   No  (both as appropriate)

 

Is everyone in your household in agreement on adopting a rottweiler?  Yes  No

 

Other pets in the household -- breed, age, spayed/neutered, up to date in vaccinations:

 

What do you know about the Rottweiler as a breed?

 

Why do you want a Rottweiler?

 

How did you hear about us, and/or  who referred you to us?

 

Do you have a preference as to what sex the rottweiler is?  Yes   No
If "yes," why?

 

Do you have a fenced yard?  Yes   No
Specifically, what kind of fence and how tall:

 

What member of the family will be taking the MAJOR responsibility for raising and taking care of this rottweiler?

 

 

What are your plans for this rottweiler?

 

Will the rottweiler live inside the home?    Yes    No    If "no," where live?

 

Where EXACTLY will the rottweiler sleep at night and be kept when there is no one at home?

 

Have you ever used a crate before?    Yes    No
Do you have an objection to using a crate? 
Yes    No   If yes, why?

 

What are the major activities, hobbies, or exercises you and your family participate in most?

 

Please list your veterinarian's name/address/phone number. 
Call your vet and advise them that I may be checking on the health care of your previous/current pets.

 

Please list names, addresses and phone numbers of three personal references that have known you for at least two years:
   

 

Are you currently or previously involved with any dog clubs, Humane Societies, etc.?  Yes     No
If "yes," what club?

 

Where exactly do your dogs live? 

 

Any additional comments you may have:

 

I certify that the information provided on this form is true & correct. I am also financially and physically able to care for this animal. I understand that proper food and veterinarian care can be costly and I am able to meet these requirements. If upon inspection we find that information contained in this questionnaire to be false, we retain the right to turn you down as a prospective puppy buyer from us.

Electronic E-Signature

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