Puppy Questionnaire
Personal information
Name
Street Address
City, State zip
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconson Wyoming Alberta British Colombia Manitoba New Brunswick Newfoundland Nova Scotia Ontario Quebec Saskatchewan Other
Telephone
Email Address
Referred by:
Below are a few questions that we would like you to answer. We are very selective in picking potential owners for our Rottweilers. We use this questionnaire to help us determine who might be a good owner for our dogs. We do not share any of this information with anyone. If you don't want to complete this form via email please call us and we shall complete the form via telephone.
Puppy Questions
What sex puppy to you prefer ? male female -- undertermined
Are you a breeder, broker Yes No --
Have you ever owned a Rottweiler before ? Yes No --
Please tell me about pets you have or had ?
Do you live in an apartment, condo, house, other ? house (own) house(rent) town house condo (own) condo (rent) apartment (rent) --- other
If you rent please provide your landlords name and phone number
Do you have access to a yard ? --- Yes No
Is the yard fenced in ? --- Yes No
Do you understand the expenses and liabilities of owning a Rottweiler. Such as vet bills and training. In the first year the vet bill can be as much as $600. . --- Yes No
You understand that some Home owners insurance companies will not provide insurance to owners with Rottweilers --- Yes No
Is there someone home during the day to take care of the puppy --- Yes No
If not explain what arrangements have been made to take the puppy out during the day.
Can you explain your household work schedule.
Do you have any children living with you. Please provide their ages.
Name, Address, and phone number of your veterinarian:
Is everyone in your household in agreement with getting a puppy, and in particular, a Rottweiler ? --- Yes No
Do you plan on using a crate/kennel for your puppy? Do you understand how this method works?
Do you understand that you are making a commitment for the dog's whole life, which could be up to 10 years? --- Yes No
Where will the puppy/dog stay most of the time ? --- Indoors outdoors kenneled staked outside
Have you ever house-trained a dog before? --- Yes No
References
(THIS QUESTIONNAIRE WILL NOT BE ACCEPTED WITHOUT REFERENCES)
Name , address and telephone number of a two reference:
By printing your name below, you acknowledge that the above information is to be true and correct. Any persons that is found misrepresenting themselves now or in the future understands that ROLI reserves the right to take possession of any dog bred by ROLI hat is sold under false pretenses. ROLI will not sell any dog to Brokers, Breeders, or pet stores.
Date