Bianca

Before acquiring a new puppy, thought needs to be given as to how the puppy will fit into your lifestyle, home and family. This questionnaire is designed to help you make important decisions prior to purchasing a puppy and to assist us in placing the right puppy with you. This will enable me match each puppy with the proper home based on the prospective owner’s lifestyle and environment and on the puppy’s personality and abilities. With this in mind, please answer all questions with as much detail as possible. All information is strictly confidential and will be used only by us. Thank you for your interest.

**Personal Information**
First Name
Last Name
Address
City
State
Zip
Home Phone
Work Phone
E-mail
Best time to contact you?
Best place to contact you?

**Housing Information**
Do you own or rent?	Own Rent
If renting, is the landlord agreeable to dog ownership?	Yes No
If renting, are you able to supply a copy of the renter's policy or written permission on pet ownership?	Yes No
Which of the following best describes your current type of home?	Apartment/Condo Townhome Single family home Other
If Other Explain.
Rural, Suburban or Urban Area?	Rural Suburban Urban
Is your yard currently fenced?	Yes No
If yes, please describe the type of fencing. Securely fenced yard, kennel run. Invisible fence. Dog house or other adequate shelter from the elements? (Invisible fencing will keep your dog in but will not keep other dogs out.)
Do you padlock your gates (if applicable)?	Yes No

**Family Information**
Please answer the following for each adult.
How many adults are living in the household?
	Name	Age range	Occupation	How long Employed?
Adult 1
Adult 2
Adult 3
Adult 4

Are there or are you planning to have children living in the household?				Yes No
If yes, how many children (please include both current and planned)?
Please list the specific ages of children
(Children six and under have a very difficult time with small puppies. A parent or sitter will have to be constantly vigilant during the early stages of socialization. Children are unable to command respect and the puppy must be taught to behave around each younger child. Children must also be taught how to handle and behave around a young puppy. This takes additional time and energy. If you have children in this age range, be sure you have plenty of extra time to work with pup and child(ren). Young children should NEVER be left unattended with the puppy.)
Are there other adults or children who visit your home on a regular basis?				Yes No
Please provide additional information regarding your regular visitors such as ages and any specific questions or concerns relating to their interaction with a dog.

Does anyone in the house or who visits regularly have any known allergies to or fear of dogs?				Yes No
What leisure activities and hobbies do you and other family members enjoy?

**Pet information**
Have you ever owned a dog before?
What types of pets are currently living in your household?
Please provide additional information regarding your current pets such as ages and any specific questions or concerns relating to their interaction with a new dog.
If yes, please answer the following about current and previous dogs.
	Name	Breed/Type	How long did you own it? (Years/months or still have)	What happened to it? (please be specific - died of what or given to whom)
Dog 1
Dog 2
Dog 3
Dog 4

What activities did you do with them? (obedience classes, talking for walks, etc.)

How did you correct or train this (these) dogs?


Are (were) your last dog(s) on heartworm prevention?				Yes No
Would you be willing to supply a copy of veterinary records on this (these) dog(s) and/or allow us to contact your veterinarian?				Yes No
If yes, please provide the following for your current or most recent veterinarian.
Clinic Name
Veterinarian Name
Address
City, State, Zip
Phone Number
Have you ever euthanized a dog?			Yes No
If so, for what reason?

**Desired Characteristics**
How did you hear about us?
How did you learn about the American Eskimo?
What is your reason for choosing this breed?
Do you have a gender preference?	Either Male Female
What is your reason for this gender preference?
Are you wanting this dog for Pet/Companionship or for Show, Breeding, Agility, Pet Therapy work or other.	Pet/Companionship Show, Etc.
If Pet/Companionship do you accept that the dog will have to be neutered or spayed?	Yes No
Are ALL Family members in agreement on getting an American Eskimo Puppy?

**Responsibility**
Who will be primarily responsible for taking care of the dog? (Feeding, walking, grooming, etc.)
Is this person aware of the time and energy needed to care for a young puppy and willing and able to accept that responsibility?	Yes No
Are you willing to obedience train this dog through training classes in order that he/she will become an enjoyable companion and canine good citizen?	Yes No
Do you plan to use a crate for Housebreaking?	Yes No
If not, what other method do you plan to use?
Do you own a crate to house the dog while unattended?	Yes No
Where will the dog be primarily kept?	Inside Outside Access to both through dog door
How many hours a day would the dog be left alone?
What best describes where the dog will primarily be when left alone (even if only for a short time)?	Inside: Loose inside home In garage In kennel/crate confined to specific area or room Outside: In fenced yard In kennel/dog run Tied to tree or stake Both: Access to both through dog door

**Long term care**
The life expectancy of a American Eskimo 15 years.
Are you willing and prepared to commit to caring for a dog for this length of time?	Yes No
Under what circumstances do you think you might need to return a dog (e.g. moving, job change, change in family status, etc.)
If something happened to you, who would care for this dog?

**Budget and Emergency Care**
In addition to the normal, everyday care and cost of a dog, emergency situations or special needs may arise.
What would you estimate as the normal annual cost of caring for a American Eskimo? (Initial puppy shots, food, heartworn & flea/tick preventative, vaccines, crate, bedding, toys, grooming products, spaying or neutering)
Will the cost of caring for this dog fit comfortably into your budget?	Yes No
Would you be able to handle the additional costs of an emergency situation?	Yes No

**Activities**
Are there other things you might like to try or learn more about or do with your dog? e.g. volunteer to assist Rescue, obedience, agility, weight pull/carting, hiking/backpacking, herding, therapy, grooming, joining national or local American Eskimo breed clubs.
What are your plans for this dog?	Pet Obedience Guard Therapy Herding Other If other please explain:

References

Please list at least 2 references

**Final comments**
Please describe what type of personality you are looking for in your American Eskimo (as an adult dog) and the type of family environment in which he/she will be living:

Can you please tell us a little about yourself and your family? (Your home, job, hobbies and interests, etc.)

Do you have any questions or comments that you feel are improtant?

My apologies for the length of this questionnaire but I feel this type of information
is very important in choosing just the right puppy for you.

Thank you for taking the time to complete it.

Date:
Signature: