Deep Run Farm
13727 Blackwells Mill Road
Goldvein, VA 22720
540-752-4888, FAX 540-752-4775
www.DeepRunRetrievers.com
Jack Jagoda         Phyllis Giroux, DVM, CAC

Working Retrievers



HARD COPY PUPPY ADOPTION QUESTIONNAIRE

(You can get the ONLINE ADOPTION QUESTIONNAIRE by clicking here)

Read more about our adoption process by clicking here



Name ____________________________________________________________

Address _________________________________________________________

City, State, Zip ___________________________________________________

E-mail ________________________________

Phones: Home ________________ Work __________________

Mobile _________________ Pager ______________________

Number of family members: _________

Ages of children ____________

How many family members are home during the day? _____

If no one, who will care for the young pup? ______________________

Where will the dog sleep? ___________________________________________

Do you own or rent? __________

How long at current address? __________

Is your yard fenced? Please note, we think all retriever puppies should have a fenced yard. _________

Describe your fence __________________________________________________________________________________

If you are planning an invisible fence, how will you contain the pup until it is old enough to use the invisible fence? _________________________________________________________________________________________________

Explain why you want a dog ______________________________________________________________________

Who will be responsible for training the dog? ________________________

Do you plan to have the dog trained professionally? ___________

Do you plan to have your dog spayed or neutered? This is up to you, but all our dogs are sold on Limited (nonbreeding) Registrations.__________

What happened to your last dog? ____________________________

How many other pets do you have now? ____ What kind are they, and how old? ____________________________________

If your puppy swallowed a sock and the veterinarian told you it needed an operation that would cost $2400, what would you do? _____________________________

Who is your current veterinarian, include phone number + area code ______________________________________________________

Have you used a crate to house train puppies before? ______

Have you trained any dogs to achieve titles? If so, which titles? _________ ____________________________________________

What hobbies do you have? _____________________________________

How many hours a week do you plan to spend with your dog? ________

Are you planning to move in the next 5 years? ______

What will you do with your dog when you go on vacation? __________________

Are you prepared to make this commitment for the next 14 years? _________

Do you plan to use for dog for hunting? _______

What kind of hunting do you do? ________________________

How often did you hunt this past season? __________________

Will you run your dog in any Field Trials, Hunt of Field Tests? _______

Who will train your dog for these events? _____________________

Do you plan to send your puppy back for puppy training at Deep Run Farm? _____

Will you want your pup shipped to you? ____

If yes, what is the nearest LARGE airport to you? __________________

Will you want to buy a crate to ship your pup, or send one to us for shipping? _____

Which Deep Run litter are you interested in? ____________________________

Are you interested in a male _______or female_______ pup?

Please list your color preference, (number 1 most preferred, number 3 least preferred). Black___________Yellow____________Chocolate____________. If you are only interested in one color, simply put number 1 next to that color.



Please print out and Mail the completed questionnaire to us at:
Deep Run Farm
13727 Blackwells Mill Road
Goldvein, VA 22720

or,
Email it to DeepRunRet@aol.com

or
Fax it to 540-752-4775.

Thank you for taking the time to tell us more about yourself. We will give you a call soon. If you do not hear from us within 72 hours, call us, because we didn't receive your questionnaire.