The following questions are being asked of you so that the right puppy and the right placement of each puppy is made by bringing the various
requirements of both the puppy and his or her new owner(s) into perspective, BEFORE a choice is made.  I hope you will agree that the animal's
welfare must be my foremost consideration in considering a placement.  Please answer the following questions as completely as you can, and
return this form when you've finished.  If this Questionnaire does not automatically submit, please highlight the filled-out form, copy it and
paste it into an email to:  meadowlandckcs@gmail.com


                                                          MEADOWLAND PUPPY QUESTIONNAIRE   

CONTACT INFORMATION

Name:       

Address:   

City:                State:       Zip Code: 

How long have you lived at this address? 

Email:       

Contact Phone: 



Referred by: 

What reference materials have you read?  How many individuals of this breed are you acquainted with?


Type of Dwelling:  house     condo     apartment     mobile home

If renting please give name and address of landlord: 

Name, address and phone number of your veterinarian:


Who will be the primary care giver?

Where will the puppy be kept during the night?

Where will the puppy be kept during the day?

How many hours on the average will the puppy be left alone?

Will there be someone available to feed and exercise the puppy during the day?

Have you ever owned a dog before?  Yes     No

Do you have other animals?  Yes     No

Do you have any children?  If yes, what are their ages? 

Does anyone in your household have allergies to animals?  If you, to what and how severe?


Are you interested in a male or female puppy?     Male     Female      No Preference

At what age do you wish to get the puppy?

Have you considered an older dog instead of a puppy?  Yes     No

How did you hear about this breed? 

What do you expect the activity level of this breed to be?  Very high     High    Moderate      Below Average

What kind of floor surfaces will the dog be on in the house? 

How many hours a day will th epuppy be kept outside?

How will he be confined when he is outside? 

Do you have a fenced yard or suitable pen?  Yes     No

Have you ever house trained a dog before?  Yes     No

Will you be attending any training classes?  Yes     No

If yes, at what age will you start, which activities or competitions are you interested in, who is the trainer?


How long did your last pet live?  What were the circumstances of his/her death?


Have you ever returned a pet to the breeder?  If so, what were the circumstances?


Have you ever given a pet away?  If so, what were the circumstances?


Have you ever taken a pet to a pound or shelter?  If so, what were the circumstances?


Are you interested in showing the dog in the conformation ring?  Yes     No

Have you ever shown a dog to it's championship?  Yes     No

Are you interested in competition in performance events such as obedience, agility, hunting, herding, etc.?  Yes     No

Have you shown a dog to any performance titles?  Yes     No

Do you intend to breed the dog?  Yes     No

Do you understand the difference between a limited registration and a full registration?  Yes     No



Thank you for completing my Questionnaire.  When you are ready please click Submit.  If you wish to start over,
please click Reset.  If this Questionnaire does not automatically submit, please highlight the filled-out form, copy it and
paste it into an email to:  meadowlandckcs@gmail.com