Name * First Name Last Name Email Address * Phone Number * (###) ### #### Mobile Phone For text messages (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Spouse or Partner (if applicable) First Name Last Name We select which puppy goes to each family but we like to know if you have a preference? * We only breed black and yellow Labrador Retrievers. All ASQUAM Labradors are sold on an AKC Limited Registration. Black Labrador Yellow Labrador No preference Male or Female: * Male Female No preference Companion or Performance Dog (Obedience, Hunting, Rally) * Performance Dog Companion Do you live in a * House Apartment Condo Townhouse If you rent your home, please provide landlord's contact information. How many adults live in your home? * Your occupation? * Typical hours of work per week? * Occupation of spouse/partner? Typical hours of work per week? Who will be the primary caretaker of the dog? * Do you have any children? * Please list your children's ages. Is there anyone else who will be living with the dog? * Yes No What types of activities do you enjoy as a family? * What family activities will your dog be a part of? * Have you ever owned a dog? * Yes No If Yes, what breed or mix? How was your dog obtained (purchased, found, given as a gift, adopted, etc.) Age of dog when obtained? What happened to your dog(s)? * (sold, given to others, taken to the pound, lost, died – include the cause of death) Do you Breed dogs now, or have an experience breeding dogs? * Yes No Do you currently own any other pets? * Yes No If yes please list: Do any family members have allergies to pets? * Yes No Where will your dog live? * Inside home Garage Basement Outside combination of all Where will your dog spend time when no one is at home? * Will your dog be going to Day Care? * Yes No Where will the dog sleep at night? * Are you aware that Labrador Retrievers are not normally barkers, but they are chewers and diggers especially if left alone? * * Yes No How do you plan to exercise your dog? * Who will be available to feed and exercise the dog during the day? * Please explain Do you have a fenced in yard? * Yes No If yes please describe: Do you have kennel runs? * Yes No Do you have parks nearby? * Yes No May I come to see your facilities? * Yes No How will your dog be transported? * Describe your property in regards to placement and the street, ie., moving traffic, speed limits. * Are you willing to crate train your puppy? * Yes No When you travel would you normally travel with the dog * Yes No What arrangements would you make for the care of the dog when it is unable to travel with you? * Are you willing to take the puppy to obedience classes? * Yes No Have you ever used a gentle leader on a dog? If yes, how was it effective? * Have you ever used a harness on a dog? If yes, how was it effective? * Have you ever used a prong collar on a dog? If yes, how was it effective? * Have you ever used an electric collar on a dog? If yes, how was it effective? * Do you have a veterinarian? * Yes No If yes, please provide contact information. Do you plan to spay or neuter your puppy? * Are you willing to sign a Non-Breeding Agreement? * Yes No Are you willing to sign a contract authorizing me to take the dog if you provide me with false information or do not care for it properly, and requiring you to return the dog to me if you are no longer able to care for it properly? * Yes No Have you read our Asquam Labrador Purchase Agreement? * Yes No Do you understand you must keep your Asquam Labrador intact until 18 months of age? * Yes No Are you currently on a waiting list or do you have a deposit with another breeder? * Yes No Why have you decided to buy a Labrador Retriever? * Are you aware of health problems, which may affect a Labrador Retriever quality of life? And are you willing to purchase Trupanion pet insurance for your labrador? * Please describe below: How did you hear about Asquam Labradors? * List two personal, non-family references - Name, phone, relationship * If there are any other comments you would like to make, or information or questions you would like to have answered, please write them below. Thank you for taking the time to fill this out!Nancy Wolston