Anyone interested in getting a puppy/dog or on the puppy waiting list, must fill out a questionnaire. This questionnaire helps me to make sure my Brittany puppies and you would be a good match. It also helps me to know what questions to ask during our face-to-face or phone interview. This questionnaire is the first step. Some of the questions may seem silly...some may seem intrusive. Please remember that I'm not trying to pry. I'm just trying to make sure the puppies I help to bring into the world go into the best possible homes. Form Rules: You may use the TAB key to move from field to field. You may use the ENTER key in text boxes ONLY...any other time you hit the ENTER key...the form will be sent. If you accidentally send the form, hit the back button and continue filling out the form and send it when you are finished. I will email you when I receive the form. If you do not hear from me within 48 hours, I may not have received your form. Please email me and send a new form. You can also email me (gonorthbrittanys@yahoo.com) if you have any questions. Your Contact Information: Today's Date: Your name: Your address: City, State Zip Your home phone number: Don't forget your area code. Your work phone number: Don't forget your area code. Your cell phone number: Don't forget your area code. Your e-mail address: How would you prefer I contact you? Home Phone Work Phone Cell Phone OR Email If by phone...what time would you prefer I call? What time zone are you in? Other Eastern Central Mountain Pacific Alaska If you have a website address, please put that info here: Your Puppy/Dog Preferences: Are you interested in a particular puppy/dog on my site? Yes OR No Name of puppy/dog. What sex puppy/dog are you looking for? Male Female Either If you have a preference, why this particular sex? If your preferred sex is NOT available, are you interested in getting a puppy/dog of the other sex? Yes No I'm not sure What color puppy/dog are you looking for? You MAY choose more than one. If you have a MORE preferred color, let me know in the text box below. Orange and White Liver and White Orange Roan Liver Roan Tri Color Understand that a Tri Colored Brittany is NOT a preferred color per the AKC Breed Standard and all Tri Color puppies will be sold with a spay/neuter contract and with LIMITED AKC Registration. Tri Colors are NOT breeding/show prospects. My MOST preferred color is: What age puppy/dog are you looking for? Not Sure Under 3 Months old Under 6 Months old Under 1 year old 1-3 years old Over 3 years old Is this puppy/dog for yourself or another member of your household? Yes OR No If NO, who is the puppy/dog for? Is this puppy/dog for a surprise gift? Yes OR No What are your plans for this puppy/dog? Check ALL that apply. Pet/Companion Breeding Prospect Confirmation Show Prospect Field Trial Prospect Hunt Test Prospect Hunting Prospect Agility Prospect Obedience Prospect Rally Prospect Tracking Prospect Nose Work Prospect Search and Rescue Prospect Therapy Work Prospect Other If OTHER, please describe. Are you planning to take this puppy to puppy/obedience classes? Yes OR No Your Dog History: Have you ever owned a dog before? Yes OR No How long ago? I've never owned a dog. I own dog(s) now. When I was a child. Less than a year ago. More than a year ago, but less than 5 years ago. Over 5 years ago. If YES to above question...have you ever owned a Brittany before? Yes OR No How long ago? I've never owned a Brittany. I own a Brittany(s) now. When I was a child. Less than a year ago. More than a year ago, but less than 5 years ago. Over 5 years ago. Have you ever raised a puppy before? Yes OR No If yes, what breed? In the area below, please, tell me about any pets you CURRENTLY have including type (dog, cat, gold fish...etc.) / breed / sex / age, or anything else you think would be helpful. Please tell me about any pets you've had in the past 5 years, but no longer own. What happened to them? Have you (in the past 5 years) given a dog away, returned a dog to the breeder, or turned a dog over to a shelter or rescue group? Yes OR No If YES, when and why? Why are you interested in getting a Brittany at this time? Your Home Environment: In the area below, please, tell me about the members of your household. Please list all adults, and the sex and ages of all children. Are you planning to add other members or pets to your household (someone moving in, birth of a child, getting a cat) in the near future? Yes OR No If YES, please describe? What type of home do you live in? Other House Apartment Trailer/Mobile Home If OTHER, please describe? How long have you been in this home? months OR years Do you... own OR rent If you RENT, do you have your landlord's permission to keep this type of dog? Yes OR No If NO, what are your plans to resolve this? May I speak with your landlord? Yes OR No Landlord's name: Landlord's phone: Do you have a fenced yard? Yes OR No If YES, yes please describe the type (chain link, wooden) and the height. Do you have a separate kennel run for the dog? Yes OR No If YES, yes please describe the type, height, and flooring. If you do not have a fenced yard or kennel, how will you handle the dog's exercise and toilet duties? How the puppy/dog will spend an average day: How many hours (in the average day) will the puppy/dog spend alone? Where will the puppy/dog spend most of the day? Other loose indoors confined to part of the house loose in fenced yard kennel run garage basement loose outdoors (no fence) tied in yard crate If OTHER, please describe? How will the puppy/dog spend the night? Other loose indoors confined to part of the house loose in fenced yard kennel run garage basement loose outdoors (no fence) tied in yard crate If OTHER, please describe? Last Little Bit: Would you be willing to let me visit your home by appointment? Yes OR No Are you over 18 years old? Yes OR No If NO, do you have your parent's permission and support in getting this dog? Yes OR No Please list your parent's name and phone number here. Please list at least one personal reference. Include a name and phone number for each. Thank you so much for filling out this questionnaire. I know it's a little lengthy, but it really helps me in placing puppies into compatible homes. Please add any comments you have below: