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Puppy Questionnaire

Please fully complete the questionnaire below. This questionnaire is just the beginning step in the interview process. You MUST complete the questionnaire to be considered as a potential home. There is a section at the end of the questionnaire should you want to include any additional information.



City, State, ZIP:

Phone Number:

E-Mail Address:

How did you hear about us?

Which breed are you interested in? Bullmastiff Rottweiler
Are you looking for a:     Male     Female     Puppy     Older Dog

What specific qualities are you looking for in a dog? What are your goals for this dog?

About your family:
How many adults live in your home?

How many children?    Ages of children:

Do you currently own a dog(s)? Yes No
If so, what breed and age?

Do you own any other pets? Yes No
If so, what type and age?

Please tell us about your lifestyle, work schedules etc.

About your home:
Is the area that you live in
Rural Suburban City
Do you Own Rent?
Will this dog live Indoors Outdoors?
Will this dog have access to a fenced yard? Yes No
Are you comfortable crate training your puppy? Yes No

Please tell us about your past experience with dogs. List all the dogs you have owned and what happened to them. Please list any dog-related clubs you belong to.

Please provide us with two references. If you have previously owned a dog, one of the references must be a breeder, veterinarian, or trainer.

Here you can include any information you feel relevant, that you would like us to consider.

By submitting this application I am acknowledging that this information is true and correct. I understand that sending this application does not automatically entitle me to a dog. I also understand that this questionnaire is just the beginning of the interview process.
I Agree I Disagree


Gina M. Cecconi except where indicated
Do not duplicate or redistribute without prior permission