All information is kept
PO Box 780, Loon Lake, WA 99148-0780
Cell phone: (Mark) 509-844-3544 (Sandra) 509-844-3214
Please complete this questionnaire to
assist us in placing the appropriate puppy in your home. While I
understand that it seems lengthy, please understand that it is vital for
us to have as much information as possible so that we can match the needs
of both your home and the individual puppy. Feel free to elaborate on any
questions using additional pages. The more information you can provide us
about your home, needs, and wishes, the better we can match you with a
Prospective Owner Questionnaire;
Name: ___________________________________________ Date: __________________________
Phone: (Home) __________________________ (Office) ___________________________________
E-mail address: ____________________________________________________________________
Please list names and occupation of
all adults in the household: ____________________________
Do you have children/grandchildren who visit regularly?
NO ___ YES ___ # of
INFANTS _____ # of 1 – 5 yrs ______
If you don’t currently have children, do you plan to in the future? YES___ NO ___
Why do you want a Border Collie?
Have you owned a Border Collie before? YES___ NO___
Please check any of the following activities you plan on participating in with your Border Collie?
agility___ tracking___ free style ___
Please list the highest level of
titles and wins you have achieved with your dogs (owner handled or
Do you intend on obedience training your Border Collie? NO ___ YES ___
ON YOUR OWN___ WITH A
CLUB ____ CLUB NAME _______________________
Do you hope to breed Border
Have you ever done any breeding of
dogs before? NO___
What other pets or animals do you own? DOG___ # _________
____________________________________________ CAT___ #
Do you or your neighbors have livestock? YES___ NO___
Where will the dog be while you are home? INSIDE___ OUTSIDE___ BOTH___
Where will the dog sleep as a
puppy? INDOORS: LOOSE ___ CRATED ___
Where will the dog sleep as an adult? INDOORS: LOOSE ___ CRATED ___
IF CRATED WHERE WILL THE CRATE BE
How long will the dog be alone each day? LESS THAN 2 HRs___ 2-4 HRs___ 4-8 HRs___
MORE THAN 8 HRs___
Who in your family will be primarily
What arrangements will you make for
the dog's care when you are away from home for an extended period of time?
UNATTENDED WITH ADEQUATE SHELTER,
FOOD AND WATER___
When the dog travels with you in your
vehicle where will it ride?
Do you have a fenced area for the dog? NO___ YES___
aprox. size _______ x _______
type of fencing BLOCK___ WOOD___ CHAIN LINK___ OTHER_____________________
fence height 3'___ 4'___ 5'___ 6'___
type of shelter DOG HOUSE___ SHADE TREES___ PATIO___ OTHER______________
type of area YARD___ DOG RUN___ OTHER______________________________________
surface GRASS___ CONCRETE___ DIRT___ OTHER_____________________________
Have you ever used a crate in housetraining a dog? NO___YES___
Clinic Name: ________________________________________________________
Do you currently belong to any dog
Please check all that apply to the type of dog you are looking for:
MALE___ FEMALE___ NO PREFERENCE___
ROUGH COAT___ SMOOTH COAT___ NO PREFERENCE___
PRICK EARS___ TIPPED EARS___ NO PREFERENCE___
BLACK/WHITE___ RED/WHITE___ OTHER_________________ NO PREFERENCE ___
LOW DRIVE___ MEDIUM DRIVE___ HIGH DRIVE___
Please describe any other particular physical or character attributes that are important to have in your puppy?
How did you find us? ADVERTISEMENT___ REFERRED BY WHO ____________________
Please provide the names, addresses, and phone numbers of at least three references that I may contact. These may include dog trainers, Border Collie owners, other dog owners, your veterinarian, friends, or neighbors. Anyone who knows you well enough to recommend you as a dog owner (family members excluded, please).
I certify that the information I have provided is true and complete to the best of my knowledge and that all household members have taken part in filling out this questionnaire.
Signature _________________________________________ Date: __________________________
Thank you for taking the time to answer these questions. While I understand that it seems lengthy it is vital we have as much information as possible so that we can meet your needs as well as the puppies. ALL INFORMATION IS HELD IN THE STRICTEST OF CONFIDENCE AND WILL NEVER BE SOLD OR RELEASED.