Premier Danes
PUPPY OR DOG PLACEMENT QUESTIONNAIRE Page 1 of 3
NAME(S): ________________________________________________________ HOME PHONE: ______-______-_______
WORK PHONE: _____-_____-______ x____ CELL PHONE: _____-_____-______ OTHER PHONE: _____-_____-______
HOME EMAIL: ______________________________________ OTHER EMAIL: __________________________________
PHYSICAL STREET ADDRESS: ________________________________________________________________________
This is NOT a test. There are no right or wrong answers. Please answer thoughtfully and completely.
IF THERE ARE MULTIPLE PEOPLE IN THE HOUSEHOLD, PLEASE FILL THIS OUT TOGETHER.
These questions should help you understand how a puppy or dog may affect your life. Your responses will be used to help make the best possible match of a puppy or dog with your family members, home and lifestyle.
How many people live in your house? ________ How many are adults? ____________ How many are children? __________
If children, what are their ages and genders? ________ _________ _________ ________ ________ ________ ________
Who else lives or spends a significant amount of time in your house, such as a nanny, housekeeper, elderly parent, grandparent, grandchildren or other? ______________________________________________________________________
Will your dog "belong" to a particular family member? _____ If Yes, to whom? ______________________________________
Is everyone in the household in agreement on acquiring a new dog? _______ If No, who is not and what are their concerns? ____________________________________________________________________________________________________
Is there anyone in your home who is allergic, doesn't like or is afraid of dogs? ________ Who? ________________________
If so, how do you plan to accommodate this person? __________________________________________________________
How did you first learn about Great Danes and why would you like to own one? _______________________________________ ____________________________________________________________________________________________________
Do you have any pets now? ____ If Yes, what kinds, how many and are they altered? _______________________________
____________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________
If you now own or have owned dogs before, where did you get them, what were they like, and what happened to them? ____________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________
Have you ever had a pet hit by a car or lost and not recovered? ____ If Yes, please explain. ___________________________
____________________________________________________________________________________________________
Describe the MOST IMPORTANT CHARACTERISTICS you are looking for in a dog (REQUIRED) ______________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________
Do you prefer a male or a female – in what order - or no gender preference? _______________________________________
If so, why? _______________________________________ Will you switch if a puppy of that gender is not available? ______
Do you plan to spay or neuter your dog? _____ If no, why not? __________________________________________________
What hobbies or activities do you or your family enjoy? ________________________________________________________
____________________________________________________________________________________________________
Will your dog participate in any of these? _______ Which? _____________________________________________________
Do you plan to do any of the following activities with your dog? _____ Please check all that apply.
( ) obedience training classes, ( ) obedience shows, ( ) breed conformation shows, ( ) breeding, ( ) rally, ( ) agility,
( ) Canine Good Citizen, ( ) therapy.
Do you have experience in any of the above? _____ If so, please explain. _________________________________________
____________________________________________________________________________________________________
Your Name:____________________________________ Page 2 of 3
Do you live in a single family house, duplex, condo, apartment, trailer or other? Which?____________________________
If you rent, does your lease allow dogs? ______ Do you have a letter or proof of permission?________________________
Do you have your own yard? _______ Is your yard completely fenced so that the dog could not escape?_______________
If Yes, is your fence conventional or invisible? ___________ If conventional, what type?____________________________
If No, what arrangements will you make to keep the dog on your property?_________________________________________
____________________________________________________________________________________________________What size is your yard? ________ Any other enclosure for a dog? ______ Please describe _________________________
Describe your street, the traffic on it and the speed limit. _______________________________________________________
Describe the neighboring streets. _________________________________________________________________________
Is someone usually home during the day? ______ If Yes, who and when? _________________________________________
If No, is someone planning to come home during the day on a regular basis?______ If Yes, who and when? ______________
____________________________________________________________________________________________________
If No, are you planning on any other form of daytime care?______ If so, please describe. _____________________________
____________________________________________________________________________________________________
If planning on daytime care, will this be only during puppyhood or will this schedule continue when the dog is mature?_______
Do you have a crate? _____ If No, are you getting a crate? _______ Do you have prior experience using a crate?__________
How many hours per day will the dog spend in the crate? ____ Where will the crate be located?________________________
Where will the dog be while you are at home? _______________________________________________________________
Where will the dog be kept while you are out? _______________________________________________________________
Where and how will your dog spend most of his time during the day? _____________________________________________
____________________________________________________________________________________________________ Where will the dog sleep at night?_________________________________________________________________________
Are you prepared and willing to give this dog the love and care required for its entire lifetime?____
Are you financially prepared and willing to give this dog the routine and medical care it will require for its lifetime? __________
If you could not care for this dog in the future, what arrangements would you try to make for this dog?____________________
____________________________________________________________________________________________________
How did you get my name?_____________________________________________________________________________
Please list your Veterinarian and two other NON-FAMILY MEMBER references with their phone numbers.
By providing this information, you are giving your permission for me to contact them.
Your current or former veterinarian ____________________________________________________ _____-______-_______
1. _______________________________ _____-______-_______ 2. _________________________ _____-______-_______
If there are any other comments you would like to make, or information or questions you would like to have answered, please write them below.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please note that filling out and returning this questionnaire does not in any way guarantee that you will get a puppy or older dog from Premier Danes.
PLEASE RETURN THIS FORM AS SOON AS POSSIBLE IF YOU ARE INTERESTED IN
A PUPPY. THANK YOU FOR YOUR RESPONSES.
Please email to jillcstout@yahoo.com. or mail to: Jill Stout 4860 S. San Paulo Ave. Sierra Vista AZ. 85650
If you do not hear back within a couple of days, please contact me to make sure your Q was received. Thank You.
COMPATABILITY SUMMARY
Your Name:____________________________________ Page 3 of 3
CIRCLE OR BOLD OR COLOR OR HIGHLIGHT ALL THAT APPLY
Have you owned a dog before?
As an Adult
YES or NO
As a Child
YES or NO
Have you personally housetrained a puppy?
As an Adult
YES or NO
As a Child
YES or NO
The last time you owned a dog was
Within the last 2 years
3 – 10 years ago
11 or more years ago
I currently have _______ dog(s)
Breeds / sizes?
_______________
_______________
Neutered?
YES or NO
Your new dog needs to be good with
Kids over 5 yrs
How many? __
Kids under 5 yrs.
How many? ___
Elderly or Disabled Persons
Other Dogs
Cats
Any other kinds of animals?
__________
Your new dog will primarily spend the day
As an inside house dog
As an outside dog
Inside, with you visiting at lunch
inside with visits by Dog Walkers
At Doggy Day Care
At work with you
Your new dog needs to be able to be alone each day
Rarely more than 1-2 hours
3-4 hours
5-6 hours
7-8 hours
9-10 hrs
11 or more hrs
When you ARE at home, you want your dog to be with you
All of the time
Some of the time
Little of the time
None of the time
When you are NOT at home, your dog will spend it’s time
Loose in the house
In a crate in the house
In the garage
Loose outside in the yard
Tethered or tied in the yard
In a dog run outside
Where will your dog get potty time, exercise & playtime?
In your own fenced-in yard
In your own
NON-fenced yard
On walks
At a dog park
Other: _________
_______________
You want a new dog for
A family companion
A guard dog
Hunting
Herding
Therapy
Other?
___________
You want a dog for competing in
Breed Conformation
Obedience
Agility
Rally
Dock diving
Hunt tests
What activity level do you prefer for your new dog?
Very High
High
Moderately High
Moderate
Moderately Low
Low
How Enthusiastic do you want your dog to be in showing affection for you and other people?
Extremely
Very
Somewhat
A little
Not at all
Not Important
How Playful or Energetic do you want your dog to be?
Extremely
Very
Somewhat
A little
Not at all
Not Important
How Laid Back or Calm do you want your dog to be?
Extremely
Very
Somewhat
A little
Not at all
Not Important
How comfortable or experienced are you in training your new dog for basic obedience?
Extremely
Very
Somewhat
A little
Not at all
How comfortable or experienced are you in training your new dog to avoid or remedy bad manners, such as jumping, stealing, barking and pulling on leash?
Extremely
Very
Somewhat
A little
Not at all
PUPPY OR DOG PLACEMENT QUESTIONNAIRE Page 1 of 3
NAME(S): ________________________________________________________ HOME PHONE: ______-______-_______
WORK PHONE: _____-_____-______ x____ CELL PHONE: _____-_____-______ OTHER PHONE: _____-_____-______
HOME EMAIL: ______________________________________ OTHER EMAIL: __________________________________
PHYSICAL STREET ADDRESS: ________________________________________________________________________
This is NOT a test. There are no right or wrong answers. Please answer thoughtfully and completely.
IF THERE ARE MULTIPLE PEOPLE IN THE HOUSEHOLD, PLEASE FILL THIS OUT TOGETHER.
These questions should help you understand how a puppy or dog may affect your life. Your responses will be used to help make the best possible match of a puppy or dog with your family members, home and lifestyle.
How many people live in your house? ________ How many are adults? ____________ How many are children? __________
If children, what are their ages and genders? ________ _________ _________ ________ ________ ________ ________
Who else lives or spends a significant amount of time in your house, such as a nanny, housekeeper, elderly parent, grandparent, grandchildren or other? ______________________________________________________________________
Will your dog "belong" to a particular family member? _____ If Yes, to whom? ______________________________________
Is everyone in the household in agreement on acquiring a new dog? _______ If No, who is not and what are their concerns? ____________________________________________________________________________________________________
Is there anyone in your home who is allergic, doesn't like or is afraid of dogs? ________ Who? ________________________
If so, how do you plan to accommodate this person? __________________________________________________________
How did you first learn about Great Danes and why would you like to own one? _______________________________________ ____________________________________________________________________________________________________
Do you have any pets now? ____ If Yes, what kinds, how many and are they altered? _______________________________
____________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________
If you now own or have owned dogs before, where did you get them, what were they like, and what happened to them? ____________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________
Have you ever had a pet hit by a car or lost and not recovered? ____ If Yes, please explain. ___________________________
____________________________________________________________________________________________________
Describe the MOST IMPORTANT CHARACTERISTICS you are looking for in a dog (REQUIRED) ______________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________
Do you prefer a male or a female – in what order - or no gender preference? _______________________________________
If so, why? _______________________________________ Will you switch if a puppy of that gender is not available? ______
Do you plan to spay or neuter your dog? _____ If no, why not? __________________________________________________
What hobbies or activities do you or your family enjoy? ________________________________________________________
____________________________________________________________________________________________________
Will your dog participate in any of these? _______ Which? _____________________________________________________
Do you plan to do any of the following activities with your dog? _____ Please check all that apply.
( ) obedience training classes, ( ) obedience shows, ( ) breed conformation shows, ( ) breeding, ( ) rally, ( ) agility,
( ) Canine Good Citizen, ( ) therapy.
Do you have experience in any of the above? _____ If so, please explain. _________________________________________
____________________________________________________________________________________________________
Your Name:____________________________________ Page 2 of 3
Do you live in a single family house, duplex, condo, apartment, trailer or other? Which?____________________________
If you rent, does your lease allow dogs? ______ Do you have a letter or proof of permission?________________________
Do you have your own yard? _______ Is your yard completely fenced so that the dog could not escape?_______________
If Yes, is your fence conventional or invisible? ___________ If conventional, what type?____________________________
If No, what arrangements will you make to keep the dog on your property?_________________________________________
____________________________________________________________________________________________________What size is your yard? ________ Any other enclosure for a dog? ______ Please describe _________________________
Describe your street, the traffic on it and the speed limit. _______________________________________________________
Describe the neighboring streets. _________________________________________________________________________
Is someone usually home during the day? ______ If Yes, who and when? _________________________________________
If No, is someone planning to come home during the day on a regular basis?______ If Yes, who and when? ______________
____________________________________________________________________________________________________
If No, are you planning on any other form of daytime care?______ If so, please describe. _____________________________
____________________________________________________________________________________________________
If planning on daytime care, will this be only during puppyhood or will this schedule continue when the dog is mature?_______
Do you have a crate? _____ If No, are you getting a crate? _______ Do you have prior experience using a crate?__________
How many hours per day will the dog spend in the crate? ____ Where will the crate be located?________________________
Where will the dog be while you are at home? _______________________________________________________________
Where will the dog be kept while you are out? _______________________________________________________________
Where and how will your dog spend most of his time during the day? _____________________________________________
____________________________________________________________________________________________________ Where will the dog sleep at night?_________________________________________________________________________
Are you prepared and willing to give this dog the love and care required for its entire lifetime?____
Are you financially prepared and willing to give this dog the routine and medical care it will require for its lifetime? __________
If you could not care for this dog in the future, what arrangements would you try to make for this dog?____________________
____________________________________________________________________________________________________
How did you get my name?_____________________________________________________________________________
Please list your Veterinarian and two other NON-FAMILY MEMBER references with their phone numbers.
By providing this information, you are giving your permission for me to contact them.
Your current or former veterinarian ____________________________________________________ _____-______-_______
1. _______________________________ _____-______-_______ 2. _________________________ _____-______-_______
If there are any other comments you would like to make, or information or questions you would like to have answered, please write them below.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please note that filling out and returning this questionnaire does not in any way guarantee that you will get a puppy or older dog from Premier Danes.
PLEASE RETURN THIS FORM AS SOON AS POSSIBLE IF YOU ARE INTERESTED IN
A PUPPY. THANK YOU FOR YOUR RESPONSES.
Please email to jillcstout@yahoo.com. or mail to: Jill Stout 4860 S. San Paulo Ave. Sierra Vista AZ. 85650
If you do not hear back within a couple of days, please contact me to make sure your Q was received. Thank You.
COMPATABILITY SUMMARY
Your Name:____________________________________ Page 3 of 3
CIRCLE OR BOLD OR COLOR OR HIGHLIGHT ALL THAT APPLY
Have you owned a dog before?
As an Adult
YES or NO
As a Child
YES or NO
Have you personally housetrained a puppy?
As an Adult
YES or NO
As a Child
YES or NO
The last time you owned a dog was
Within the last 2 years
3 – 10 years ago
11 or more years ago
I currently have _______ dog(s)
Breeds / sizes?
_______________
_______________
Neutered?
YES or NO
Your new dog needs to be good with
Kids over 5 yrs
How many? __
Kids under 5 yrs.
How many? ___
Elderly or Disabled Persons
Other Dogs
Cats
Any other kinds of animals?
__________
Your new dog will primarily spend the day
As an inside house dog
As an outside dog
Inside, with you visiting at lunch
inside with visits by Dog Walkers
At Doggy Day Care
At work with you
Your new dog needs to be able to be alone each day
Rarely more than 1-2 hours
3-4 hours
5-6 hours
7-8 hours
9-10 hrs
11 or more hrs
When you ARE at home, you want your dog to be with you
All of the time
Some of the time
Little of the time
None of the time
When you are NOT at home, your dog will spend it’s time
Loose in the house
In a crate in the house
In the garage
Loose outside in the yard
Tethered or tied in the yard
In a dog run outside
Where will your dog get potty time, exercise & playtime?
In your own fenced-in yard
In your own
NON-fenced yard
On walks
At a dog park
Other: _________
_______________
You want a new dog for
A family companion
A guard dog
Hunting
Herding
Therapy
Other?
___________
You want a dog for competing in
Breed Conformation
Obedience
Agility
Rally
Dock diving
Hunt tests
What activity level do you prefer for your new dog?
Very High
High
Moderately High
Moderate
Moderately Low
Low
How Enthusiastic do you want your dog to be in showing affection for you and other people?
Extremely
Very
Somewhat
A little
Not at all
Not Important
How Playful or Energetic do you want your dog to be?
Extremely
Very
Somewhat
A little
Not at all
Not Important
How Laid Back or Calm do you want your dog to be?
Extremely
Very
Somewhat
A little
Not at all
Not Important
How comfortable or experienced are you in training your new dog for basic obedience?
Extremely
Very
Somewhat
A little
Not at all
How comfortable or experienced are you in training your new dog to avoid or remedy bad manners, such as jumping, stealing, barking and pulling on leash?
Extremely
Very
Somewhat
A little
Not at all
