Coburg Hills Bernese Mountain Dogs
Michelle & Steven Merfeld
P.O. Box 7874
Springfield, OR 97475
E-mail:
Questionnaire for Prospective Puppy Owners
Thank you for taking the time to fill out this questionnaire so we can understand what you are looking for. When we have litters, we want to make sure our puppies are sold to loving and committed homes for life. Please answer the following questions as completely as you can and mail the form to the address shown above or cut and paste into an email. If you have any questions, please email. All information is confidential.
Family Information:
Name:______
Partner's name:______
Referred by:______
Home address:______
City, state, and zip:______
Mailing address:______
E-mail address:______
Phone number:______
What is your occupation:______
What is your spouse's occupation:______
How many adults live in your home.______
Do you have any children? Ages of children in the home.______
Do any family members have allergies to dogs?______
If your family circumstances change (new baby, change of residence or job) what will happen to the dog?
______
Puppy Information:
What sex are you interested in?
? Male ? Female
? No preference
All our puppies are sold on AKC limited registration and spay/neuter agreements. Do you have a problem with this?
? Yes, why?______? No
Are you currently on the waiting list for any other litters?
? Yes ? No
Why have you decided to buy a Bernese Mtn Dog?______
______
Please rank the following factors in order of importance to you in your choice of a puppy (1=most important):
A.Structure______
B.Markings______
C. Temperament______
D. Sex______
E. Family companion______
F. Potential obedience dog______
G. Pet therapy______
H. Search & rescue______
I. Potential show dog______
J. 4-H or FFA project______
K. Breeding______
L. Other (______)______
Housing Information:
Do you live in:
?Apartment
? Townhouse
? Single-family residence
? Other
Do you rent or own your residence? If you rent, have you discussed a dog with
? Rent your landlord? ? Yes ? No
? Own
Do you plan on moving anytime soon?
? Yes ? No
Do you have a fenced yard?
? Yes ? No
If not, how will you provide security for your puppy when it’s outside or when you're away____
______
Is anyone home during the day?______
Where will this puppy spend the evening? ______
Where will this puppy sleep?______
Are you willing to attend group puppy training classes with this dog as a condition to adopting one of our puppies?
? Yes ? No
How many hours on the average will your puppy spend alone?______
Household Information:
Have you ever owned a Bernese Mountain Dog before?
? Yes ? No
If so, where did you purchase it from?______
If you haven't owned a Bernese Mountain Dog before, what other breed of dog have you owned?
______
Do you still own the dog(s) mentioned above? ? Yes ? No
If not, what happened to the dog(s)______
______
Please list all pets currently in your household______
______
______
Who will have primary responsibility for the care of this puppy? ______
______
Do all family members agree on the addition of a Bernese Mtn Dog to the family?
? Yes ? No, why?______
Please give us the name, address, and phone number of your veterinarian (or one that has worked with you in the past
______
______
Have you ever returned a dog to the breeder? If so, what were the circumstances?
______
______
______
Have you ever been charged with animal abuse or neglect?
? Yes ? No
Have you ever given a dog away? What were the circumstances?______
______
______
Have you ever bred a dog/dogs before? If so, please elaborate.______
______
______
Please give us any other information you think will help us get to know you and your needs with respect to placing a puppy most suited to your family/lifestyle:
______
______
______
______
As a condition for having one of our puppies, we require that if some unforeseen circumstances happen, that the dog be returned to us. Do you agree to follow this requirement? ? Yes ? No
Although we strive to produce healthy Bernese Mtn Dogs do you understand and agree that there is no guarantee that the puppy/dog purchased from us will be free of genetic defects although proper screening of both parents is done?
? Yes ? No
Thank you for taking the time to fill out this questionnaire and provide us with important answers. Sincerely, Steve and Michelle
______
Signature(s) Date
COBURG HILLS BERNESE MOUNTAIN DOGS
PO BOX 7874, SPRINGFIELD, OR 97475
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