PUPPY QUESTIONNAIRE

This Questionnaire is for the purpose of selection and placement of a dog/puppy in a positive environment. Any and all information given herein will be used solely for that purpose. Please be as detailed as you can in your descriptions or it may effect the decision of the breeders to consider you as a good home. If for any reason we do not have a puppy/dog that fits with your requirements, then we will forward this questionnaire to another Code of Ethics Kennel.

Name:                 

Street Address:   

City:                   

State:                 

Zip Code:            

Home phone:       

Work:                 

Cell:                    

email:                 

Website:             

Good time to call if we need to reach you: 

How were you referred to us? 

Why are you interested in obtaining a dog from Vom Mitternadt ?

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You are interested in (check all that apply):
Puppy  Adult  Male  Female  Information Only  Handling Services  Pedigree Research

Structure/Size preferences:
Large/Robust  Correct to Standard  Small  None

Reason you want to own one of our dogs (be specific so we can refer trainers to you):
Companion/pet  Show/Breeding  Obedience Ring  Protection/Working Ring  Tracking  Carting

What qualities do you expect in this breed? 

What qualities do you not want in this breed? 

Is this your first time with this breed?  Please Choose Yes No

Why do you want to own this breed?

Tell us about previously owned dogs:

Animals present at home now: 

Have you examined our Contract?  Please Choose Yes No

Do you understand the spay/neuter agreement for pets?  Please Choose Yes No

Are you committed to caring for this dog for its lifetime?  Please Choose Yes No

Do you have a training facility in your area?  Please Choose Yes No Do not know

If you are considering breeding, do you understand our policy on required OFA and other health exams prior?  Please Choose Yes No

Can you contact us prior to breeding for information that might benefit the offspring of this Rottweiler?  Please Choose Yes No

Vom Mitternadt  reserves the right to do a check on any placement homes for our puppies at a time that is mutually agreed upon, if the home is in question before or after a placement has been made.  Please keep us informed if anything on this application should change.  Do you agree to these terms?  Please Choose Yes No

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Family Data

Are you:  Please Choose Married Single Divorced

Do you have children?  Please Choose Yes No

How many children? 

What ages? 

Others in the household that will have contact with the dog? 

Who will be responsible for this dog? 

Where will this dog stay during the day? 

Where will this dog stay during the night? 

You live in a  Please Choose Urban Suburban Rural area

You Please Choose Own Rent your Please Choose Home Apartment

Have you read information about Rottweiler care, training and understand the responsibilities?  Please Choose Yes No

Do you have all the equipment, a proper crate and other materials for your dog?  Please Choose Yes No Do not know

What will you be feeding this Rottweiler as a diet? 
Vom Mitternadt recommends Pro-Plan brands and will supply you with a starter kit and coupons. We also suggest Hokamix and Nupro for growing puppies and working adults. 

Have you checked into Breed/Training clubs in your area?  Please Choose Yes No

Where is it located and who will be training with you and your dog?

Any additional information that may help us make our decision:

Vom Mitternadt   reserves the right to turn down any homes not deemed suitable for our puppies and dogs.  We would like to Thank You for taking the time to fill out this Questionnaire.

Please click the Submit button to send us this form.

 

   

 

CONTACT: JOANNA LOCKNER  -  EMAIL: LOCKNER99@YAHOO.COM
HOME PHONE: 309-446-9214  -  CELL PHONE: 309-208-3955
The best time to contact me is after 3pm CST.

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