MiMAR AKITAS
5612 Norquest Blvd.
Austintown OH 44515
PUPPY QUESTIONAIRE
PERSONAL INFORMATION
Name(s): ______
Address: ______
City: ______State: ______Zip: ______
Phone No. ~Primary: ______~Alternate: ______
Email Address: ______
RelationshipStatus: Single ______Married ______Divorced ______Living Together ______
Ages of Adults in your residence: ______
Ages of Children in your residence: ______
How were you referred to us: ______
Do you own any other dogs? ? Yes / No If yes, list breed(s), age(s), neutered / intact, and sex(es): ______
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Do you or have you ever owned an Akita before? Yes / NoIf not, why do you want an Akita now? ______
Do you have any other animals that live in your house or in your yard? Yes / No If yes, please list: ______
Have you ever returned a puppy/dog to the breeder or surrendered a dog to a pound? Yes / No If yes, what was the reasoning for the return / surrender? ______
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Have you done any research on the Akita breed? ______
Do you realize the Akita temperament traits, dominance, and possible aggression towards other animals? Please explain: ______
How would you deal with an issue of dominance or aggression with other animals in the home?
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Who will be the primary caregiver / trainer for the puppy? ______
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RESIDENCE INFORMATION
Do you own or rent your residence? ______
Do you reside in an apartment, condo, house, or townhouse? ______
If you rent, does your landlord approve of an Akita? Yes / No
Does your homeowner / renters insurance cover Akitas? Yes / No
Do you have a fenced yard or suitable pen / kennel? Yes / No
If yes, how tall is the fence or what are the dimensions of the pen / kennel? ______
If not, are you willing to put up a fence or put up a suitable pen / kennel for your dog?
Yes / No If not, how will you contain your dog on your property? ______
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PUPPY INFORMATION
Do you want a male or female puppy? ______Would you accept either sex? Yes / No
Do you want a show quality or companion puppy? ______
Would you be interested in a long coat? Yes / No
All companions are sold as spay / neuter at the age of 9 months. Are you willing to agree to spay / neuter your puppy? Yes / No
We require all of our puppies to attend Puppy Kindergarten and Obedience classesfor socialization. Do you agree to enroll your puppy in a Puppy Kindergarten and Obedience classes? Yes / No
Do you understand the difference between a Limited Registration and a Full Registration? Yes / No
YOU AND YOUR PUPPY
How much quality time will you spend with your dog (daily average)? ______
Percent of time your puppy will be in your home: ____% yard ____% kennel ____% crate ___%
Where will your dog be kept when you are away for 4-8 hours? ______
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Where will your dog be kept when you are on vacation? ______
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Will you be crate training your puppy? Yes / No If not, where will your puppy’s primary sleeping area be? ______
PURCHASING A SHOW PUPPY (complete if you are purchasing a show puppy)
Have you exhibited at AKC, UKC, CKC dog shows or matches? Yes / No In the breed ring? Yes / No In the obedience ring? Yes / No In the rally ring? Yes / No In the agility ring? Yes / No
How many dog shows do you attend each year (AKC, UKC, CKC, etc)? ______
Have you obtained Titles for any dog you have previously owned? Yes / No If yes, what titles? ______
Have you obtained a Championship or Grand Championship on a dog you have previously owned? Yes / No
Do you plan to show this dog? Yes / No If yes, who will handle the dog? ______
Do you plan to breed this dog or use it for stud? Yes / No
How many AKC litters have you produced? ______Any Akita litters? ______
How would you care for puppies not sold by 3 months of age? ______
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What would you do with any “long coats” if they were produced in your litter? ______
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Do you own any Champion or Grand Champion dogs or bitches? Yes / No If yes, please list registered name, title, and breed. ______
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Please give 3 references (Veterinarian, friend, breeder, relative, etc.) including phone number and/or email address.
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Owning a dog is a lifetime commitment and we take placing our puppies in their forever homes as a very important part of our breeding goals. We require this Questionnaire to help us both decide if you are prepared to assume the responsibility and level of care which we would like to ensure for each puppy we produce. Akita ownership is not for everyone. Being sure the Akita is the right breed for you is as important to us as it is to you. We encourage all of our prospective buyers to ask a lot of questions prior to purchasing a puppy. We also will be happy to answer your questions for the life of your puppy after the sale.
Applicant’s Signature: ______
Date: ______
Applicant’s Signature: ______
Date: ______
Please return this completed form to us via email at ; via fax at 330-599-7185; or via mail at the address listed at the top of the form. Thank you!
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