Puppy Questionnaire

*Name *e-mail Address: *Street Address: *City: *State: Zip Code: Home Phone Number: Cell Phone/Work Number: Where did You Hear about Us?
Internet
Friend
Other
Your age: Best time to contact you:
Morning
Afternoon
Eveing
Weekends
Work Schedule: Is anyone home during the day?
Yes
No
Are you familiar with Chesapeake Bay Retrievers?
Yes
No
Owned
If no, have you had the opportunity to meet an adult Chesapeake in person?
Yes
No
What color are you looking for?
Brown
Sedge
Deadgrass
I am interested in:
Male
Female
Either
How soon are you looking for a new puppy? What do you want this puppy for (check all that apply)?
Companion/Pet
Conformation/Show
Obedience
Hunting
Agility
Field Trials
Pet Therapy
Breeding
Please list people (with age) that will be living with the dog:
Do you have children that visit your home? If so, please describe:
Is the puppy for a(n) ) (check all that apply):
Adult
Child
Elderly Person
Physically challenged
You live in a:
House
Townhouse
Apartment
Duplex
Condo
Do you own or rent:
Own
Rent
If you rent, do you have landlords permission? Please provide landord information:
Do you ave a secured fenced-in yard?
Yes
No
Where will the pet be kept during the day?
Where will the pet be kept at night?
Do you own a dog crate?
Yes
No
If no, are you willing to buy one?
Yes
No
If no, why?
Where will the pet be kept when you are away from your home on a typical day?
Where will the pet be kept when you travel and are away for extended periods of time?
What is your outdoor activity?
None
Some
Active
Very Active
How will you exercise your dog?
If you can no longer keep or care for the dog, what would your plans be?
Return to breeder
Place with a family member
Contact CBR Rescue
Turn into the SPCA or local shelter
Will this be your first dog?
Yes
No
If no, what breed of dog did/do you have?
If no, and it is no longer living, how did it die?
Natural Causes
Hereditary Disease
Other
If other, please explain:
To what level did you train your dog?
Puppy Class
Beginners
Advanced/Competition
Do you plan on taking this puppy to obedience school?
Yes
No
If no, why?
List any other pets you have and whether they are spayed or neutered:
Have you ever bred a dog?
Yes
No
If yes, did the sire and dam have OFA and CERF?
Yes
No
If no, please explain why:
Have you ever sold, given away or put a dog in a shelter?
Yes
No
If yes, please tell us why:
By clicking YES, I acknowledge that all information contained in this form is true and correct to the best of my knowledge. I understand any misrepresentation of fact may result in the removal of the dog from my home by CoolWater Chesapeakes.
Yes

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