Name:

Address:

Telephone / e-mail:

Please take a few moments to answer these questions.  Your responses will be used to help me make the best possible match of a puppy with your home and lifestyle.  Thank you!

How did you first learn about this breed?  Why would you like to own a dog of this breed?

Do you prefer:  Male            Female    No preference

Do you have any pets now?  If so, what kind?

If you own any dogs now, or have owned dogs before, tell me a bit about them.  What were they like? How or where did you get them?  If they are no longer with you, what happened to them?

Do you plan to participate in any of the following activities with your dog?  Check as many as are applicable

      Conformation     Obedience     Water Trials     Tracking     Other     Clubs
      Agility

Do you have experience in any of the above activities?   If so, please tell me about it.

How many people live in your household? 1 2 3 4 5 6 7

Are there any children? YES NO   If so, what are their ages?

Will your dog “belong” to a particular member of the family?  If so, who? 

Is someone in your household home during the day? YES NO   If not, where will your dog be kept while you are out?  What arrangements will be made to care for the dog in your absence?

What hobbies or activities do you or your family members enjoy?

Would your dog participate in any of these?

Is there anyone in your home who doesn’t like or is allergic to dogs?  NO YES If so, what arrangements will you be making to accommodate this person? 

Do you live in a:     house    condo     apartment    other

If you rent does your lease allow you to have pets? YES NO

Do you have a fenced yard or other enclosure for your dog? YES NO

If not, what arrangements will you make for keeping you dog safe when he is outdoors?

Do you understand that any puppy you buy from Samador will be sold only on a non-breeding contract or a co-ownership? NO YES

Is there anything you would like me to know that hasn’t been covered in this questionnaire?  Do you have any questions you would like to ask me about this breed or about dogs in general.

Please rank in order of importance the following:

I want my dog to be a companion for my children                              

I want my dog to be competitive in obedience trials and/or agility        

I want a trophy dog that my friends will envy                                     

I want a guard dog                                                                          

I want a dog everyone will like                                                          

I want a dog that likes everyone                                                        

I want my dog to be my devoted companion                                      

I want my dog to be the most beautiful dog on the street                    

I want my dog to keep me company on walks                                    

I want my dog to be a member of the family