Name:        *
     Address:     *
     City:        *
     State:       * Zip Code: 
     Phone:       *
     E-mail Addr: *
     Occupation:   
    
Best time and way to contact you: 


How many dogs have you currently have?: 

Please list the four most recent dog(s)
included in the number above:


Breed:  Gender:  MaleFemale Age:  How Long:  

Breed:  Gender:  MaleFemale Age:  How Long:  

Breed:  Gender:  MaleFemale Age:  How Long:  

Breed:  Gender:  MaleFemale Age:  How Long:  


4. What other pets do you have in your home?
 

5. How many dogs have you owned in the past?: 
 

Breed:  Gender:  MaleFemale Age:  How Long:  

Breed:  Gender:  MaleFemale Age:  How Long:  

Breed:  Gender:  MaleFemale Age:  How Long:  

Breed:  Gender:  MaleFemale Age:  How Long:  


6. Have you ever participated in dog show,
obedience or dog sports?
Yes No

7. Have you ever trained dogs?
Yes No

8. If yes, what commands were taught?
 

9. What methods of correcting mistakes were used?
 

10. Are you familiar with crate training?
Yes No

If No, are you willing to learn more about it
and consider the use of a crate (portable cage)
as a housebreaking and transitional aid?
Yes No

11. What books or other materials have you read concerning
German Shepherds dogs, dog training or dog behavior?


12. Why do you want a German Shepherd?


13. Number of people in household:
 Adults:   Children:  Childrens' Ages: 

14. Number of hours a day will your dog be alone?:
	

15. Where will your dog sleep?:
	

16. Where will your dog spend most time during the day?
	

17. How will your dog receive physical exercise?
	

18. It is important that everyone in the family will want
this dog and spend time with it. Who will have the primary
responsibility for the care and well being of your dog?
	

19. How would you describe your household activity level?
	 Very Quiet
	 Rather Easygoing
	 Usually Active
	 Lots of Activity

20. Estimate the number of times per month adults visit you home?:
	

21. Estimate the number of times per month children visit you home?:
	

22. In addition to a regular life at home, would your dog
(check all that may apply):
	 Walk routinely with a family member
	 Compete in obedience trials or other dog sports
	 Go to obedience classes.
	 Go to work with you.
	 Travel with you.
	 Be a playmate for your children or pets.

23. Do you live in a:
	 Single family home
	 Mobile Home
	 Condominium
	 Apartment

24. Do you rent?
	 Yes
	 No

If you rent or lease, you must have written permission
from your landlord; we would like this document at the
time of any home visit.

Please complete landlord information:

Landlord's Name 
        Address 
           City   State  Zip 

25. Is your yard fenced?
	 Yes
	 No

If "Yes", please describe the size of the area, the height
and the type of fencing material:

If "No", would you fence all or part of the area or buy a kennel/run?
	 Yes
	 No

26. Are there any structures that would allow your dog to climb out
of this area? Any poisonous plants? A pool? Electrical meter or
unusual features?


27. Which sex would you prefer?
	 Male
	 Female
	 No Preference

28. Are you financially prepared to provide regular veterinary care?
	 Yes
	 No

29. Considering all dogs you have owned, what health issues have you
experienced and what kinds of routine veterinary care was given,
generally speaking:


30. Do you currently have a veterinarian?
	 Yes
	 No

If "Yes", please complete your veterinarian's
contact information:

	Vet's Name:	
           Address:     
	      City:	
      Phone Number:	

31. May we contact your veterinarian?
	 Yes
	 No

	
32. Does anyone in the home have medical conditions or physical limitations
 that might cause difficulty in caring for or living with a large, strong dog?  
	 Yes
	 No
  If yes, please explain:
  
	
33. When you go out of town who will care for the dog?
  Out of town: 
  
	
34.  If you had to move for any reason, would you bring your dog with you?
	 Yes
	 No
  If no, explain: 
  
	
35. Please add any additional information or thoughts you feel
will help us find the right German Shepherd dog for you.

*Denotes Required Field. Please return to top of form if you get an error.