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

Working Retrievers


(You can get the MS WORD 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

Email it to

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.