EmailMe Form - Puppy Questionaire

First AKC Registration
& Contact Name

Co-Owners Name

Address

Home Phone Number

Email Address

How Did You Hear About Us ?

What Are Your Living Arrangements ?

Do You Rent Or Own Your Home ?

Rent

Own

N/A

How Long Have You Lived At Your Address ?

Are There Any Bylaws, Covenant's, Or Other Restrictions On Dogs Where You Live? If Yes Please Explain.

Does Your Homeowner Insurance Company Have Any Restrictions Concerning Owning A Doberman ?

Employers Name:

How Long Have You Been Employed There ?

Please List The Name, Address, Phone Number and Email Of Your Veternarian.

Please List At Least Two Referneces. Include Name, Address, Phone Number, and Email.

What Are The Ages Of Children Living In Home?

Does Any One In your household Have Allergies? If Yes, Please List Allergies.

Do You Have Any Other Animals ? Please List Quanity And Species.

Have You Owned A Dog Before ? If So, Please List Breed, Age, And Gender.

How Long Did Your Oldest Dog Live ? What Was The Situation Behind Your Dog Passing ?

Have You Ever Had To Place A Dog With :

Please Indicate Why This Dog Was Placed.

Will This Be Your First Doberman ? Why Did You Choose A Doberman ?

Please List Any Clubs Your A Member.

What Activities Are You Interest In Doing With Your Dog ?

What Conformation Championships Have You Obtained With Your Dog/Dogs ?

International All Breed

American Kennel Club

United Kennel Club

Other

Have You Ever Competed With Your Dog For A Certificate Or Proformance Title ? Please Select What Applies.

When Are You Looking To Aquire A Doberman Puppy ?

Would You Accept Referrals To Other Breeders If Necessary ?

Yes

No

What Is Most Important To You When Choosing A Puppy ? Please Choose One.

Prefered Gender:

Male

Female

Optional

My Doberman Color Preference :

Black

Red

Blue

Fawn

Do You Accept That Companion Puppies Are Expected To Be Spayed/Nuetered And Placed On Limited Registration ?

Do You Intend to Breed Your Suribachi Doberman?

Would You Have A Problem With Co-Ownership ?

What Tests Would You Do Prior To Breeding Your Dog ?

Would You Allow Suribachi Dobermans To Assist you In Breeding Your Dog And Placing Resulting Puppies ?

Yes

No

How Do You Place Your Puppies ? Check All that Applies.

Where Will The Dog Live ?

Indoors

Outdoors

Will You Allow Your Doberman On The Furniture ?

Yes

No

How Much Time Do You Feel You Will Spend With Your Doberman On A Daily Bases ?

Do You Have A Fenced In Yard That Is Secure?

Yes

No

Please Explain Your Planned Daily Schedule For Your Doberman's Excersize and Socailizing:

Do You Have Experience With Posting Cropped Ears ?

Yes

No

What Ear Crop Style Do You Prefer ?

Are You Willing To Commit To A Public Obedience Course In Order To Obtain AN AKC S.T.A.R or CGC Title ?

Yes

No

Would You Agree To Return your Dog Back To Suribachi Dobermans In The Event You Can No Longer Keep Him/Her ?

Yes

No

How Would You Pick Up Your Suribachi Doberman Puppy ?

Ship Puppy Cargo

Fly In And Pick Up

Drive In And Pick Up

Would You Agree To Keep In Contact With Suribachi Dobermans's With Updates Of Photos And Health For The Life Of The Doberman ?

Yes

No