IMPORTANT UPDATE FOR PROSPECTIVE PUPPY BUYERS: Due to recent regulations implemented by USDA/APHIS, hobby breeders with 4 or more intact bitches will lose their hobby-breeder status and be forced to become a commercially licensed kennel if they sell any puppies "sight unseen". Even though I have only 1 female I intend to breed, I have others who are unspayed. Because I want to raise my puppies in my home and not in some concrete kennel away from human & canine contact, this means that I am unable to ship any puppies to their new homes. All new owners will need to come to Ohio to pick up their puppy. We can arrange a meeting location, and I can drive a few hours to meet you along your route, or can meet you at the airport should you decide to fly. Please contact me for more information.
Questionnaire for Prospective Puppy Buyers
Please review the Prospective Puppy Buyer Information page
before completing this questionnaire.
_______________________________________________________
There are two methods available to submit your questionnaire:
(Option 1) The first version below is a "fillable" form. You can type your answers directly into the form, then click "Submit" to have your responses automatically sent. After you have clicked "Submit," a popup ad will appear. You can choose to view the ad by clicking "finish survey" or click "Continue" at the top of the popup to return to this page.
(Option 2) The second version below is text only. To use this version, copy and paste the questionnaire into an e-mail message, then fill in your responses, and send to Genesis.
Please note: Though I try to respond within 48 hours or less, that is sometimes not possible--If you do not receive a response within a few days, I did not receive your message; please try again.
(Option 2) The second version below is text only. To use this version, copy and paste the questionnaire into an e-mail message, then fill in your responses, and send to Genesis.
Please note: Though I try to respond within 48 hours or less, that is sometimes not possible--If you do not receive a response within a few days, I did not receive your message; please try again.
Prospective Puppy Buyer Questionnaire
Form Option 1 - Fillable HTML form. You can type your answers directly into the form, then click "Submit" to have your responses automatically sent. After you have clicked "Submit," a popup ad will appear. You can choose to view the ad by clicking "finish survey" or click "Continue" at the top of the popup to return to this page.
As a breeder, my goal is to place each of my puppies in his or her “forever” home. The process I use to evaluate potential homes begins with the questionnaire below.
Each puppy is an individual. Just as no two children in a family are identical, no two puppies are exactly alike. Nor are any two prospective homes the same. During the first 8-9 weeks of the puppies’ lives, I will be observing and evaluating their physical and personality traits. And I will compare my observations to the information on each questionnaire to try to determine the most appropriate home for each puppy by matching the needs of each individual dog to each prospective owner’s lifestyle.
Therefore, the answers you provide in this questionnaire are vital in assisting me to match your home with the right puppy. There are no “right” or “wrong” answers. Some of the questions may seem personal; however, candor and honesty are very important—remember, you're asking me to trust you for the lifetime of the dog.
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Prospective Puppy Buyer Questionnaire
Form Option 2 - This form is text only. To use this version, copy and paste the questionnaire into an e-mail message, then fill in your responses, and send to Genesis.
As a breeder, my goal is to place each of my puppies in his or her “forever” home. The process I use to evaluate potential homes begins with the questionnaire below.
Each puppy is an individual. Just as no two children in a family are identical, no two puppies are exactly alike. Nor are any two prospective homes the same. During the first 8-9 weeks of the puppies’ lives, I will be observing and evaluating their physical and personality traits. And I will compare my observations to the information on each questionnaire to try to determine the most appropriate home for each puppy by matching the needs of each individual dog to each prospective owner’s lifestyle.
Therefore, the answers you provide in this questionnaire are vital in assisting me to match your home with the right puppy. There are no “right” or “wrong” answers. Some of the questions may seem personal; however, candor and honesty are very important—remember, you're asking me to trust you for the lifetime of the dog.
PROSPECTIVE BUYER INFORMATION
Name:
Address:
Home Phone:
Work Phone:
Cell Phone:
E-mail address:
GENERAL INFORMATION
Why do you want a dog?
Are you acquiring a dog for yourself or for someone else?
If for someone else, are they aware of your intentions, or is the dog to be a surprise?
Do you have children living with your or visiting regularly?
If yes, please note gender and ages.
Are you prepared to teach any resident or visiting children the proper way to conduct themselves around dogs?
How do others in your household (spouse/significant other, parents, children, etc.) feel about the addition of a Belgian Tervuren?
Who in your family will be primarily responsible for:
daily care of the dog
clean up
training
exercise
vet and food bills
How would you describe your household activity level?
Very quiet
Rather easygoing
Usually something going on
Lots of activity
How did you learn about Belgian Shepherds?
Why do you want a Belgian Tervuren?
Have you considered other breeds?
If yes, what breed(s) and why?
For each dog you currently own, please list the following:
Name – Breed or mix – Sex – Age – Is pet spayed or neutered?
For each dog you have owned in the past 10 years, please list the following:
Name – Breed or mix – Sex – Age – Was pet spayed or neutered? – Why do you no longer own the animal?
(If deceased, please give age at death and cause of death.)
Do you have other pets?
If yes, please list.
Do you regularly read any dog magazines?
If yes, please list.
Have you read any dog health or training books?
If yes, please list, and describe your general thoughts about these books?
Have you or anyone in your household ever been charged with animal cruelty?
If yes, please explain.
Have you or anyone in your household ever had any animal taken away for suspicion of animal cruelty?
If yes, please explain.
Have you or any person in your household ever had privileges suspended by the American Kennel Club, the United Kennel Club, the Canadian Kennel Club, or any other such club?
If yes, please explain.
LIVING ARRANGEMENTS
Do you live in:
apartment
house
mobile home
condo
other (describe)
In which type of area is your home located?
urban
suburban
rural
Do you own your home or are you renting?
Do you have a fenced yard?
If yes, size of yard, type and height of fencing.
If no, please explain what arrangements you will provide for housebreaking and for safe and adequate exercise.
Are there any dog restrictions or laws in your area?
Have you checked into local ordinances in your area pertaining to owning/housing an animal (e.g., leash laws, required vaccinations, dog licenses, etc.)?
Are you willing to comply with any such laws?
Have you ever used a crate in housetraining a puppy or dog?
Do you intend to use a crate for this dog?
If you have to be away from home for a few days and are unable to take the dog, what arrangements will you make to provide for his/her care?
What will you do with the dog when you go on a vacation trip?
In the event of emergency (e.g., hospitalization, natural disaster, etc.), who would take care of your dog?
If you were to move, what would happen to your dog?When you travel with the dog, where will he/she ride?
How do you envision a dog fitting into your home (schedule, indoor/outdoor activities, exercise, etc.)?
Where will the dog spend most of his/her time?
Where will the dog be when you are at home?
How long each day will the dog be alone?
Where will the dog be when you are away?
Where will the dog sleep?
YOUR INTERESTS/GOALS
Are you interested in a puppy, an older pup, or an adult dog?
Would you prefer to have a female or male dog?
Please describe any physical attributes that are of particular importance to you in the puppy/dog you are seeking at this time?
Are you prepared to spay/neuter your dog, or are you interested in breeding?
What are your goals for your dog? (Please check all that apply.)
Companion (pet) Conformation/Showing Agility Herding
Obedience Rally Tracking SAR
Therapy Dog Assistance Dog Messenger Dog Flyball
Schutzhund (Other (specify)
Please describe any character attributes which are of particular importance to you in the puppy/dog you are seeking at this time?
What do you expect of your Belgian?
What do you expect of your dog’s breeder?
GROOMING, EXERCISE, AND TRAINING
Are you aware of the grooming requirements of the Belgian Shepherd?
Are you prepared to spend the required time grooming your Belgian Shepherd?
In addition to the normal routine at home, what activities will your Belgian have?
Walk routinely with a family member
Go to classes
Compete in dog shows or performance events
Go to your place of business with you
Travel with you
Be a playmate for your children
Be a playmate/companion for other pets
Other (specify)
Do you belong to any dog or dog sports club(s)?
If yes, please list.
Have you ever trained a dog? Attended training classes?
If yes, please describe how you trained and what commands were taught.
How do you intend to obedience train your Belgian? (On your own? With a club/trainer? What commands will you teach and what training methods will you use?)
Are you aware of the SOCIALIZATION AND TRAINING requirements of the Belgian Shepherd?
Are you prepared to spend time SOCIALIZING AND TRAINING your Belgian Shepherd?
Have you ever experienced any behavior problems with past or present pets?
If yes, how did you handle those problems?
OTHER
Are you prepared for the responsibility of caring for this dog for its entire life (10-16 years)?
How did you learn about Genesis Belgians?
May I or my representative visit your home?
If no, why not?
Please add any additional information or thoughts that you feel would help me to understand you as a potential Belgian owner and the home you can offer the dog.
What questions do you have for me?
VETERINARIAN INFORMATION / REFERENCES
If you have a veterinarian, please provide contact information below
Name
Address
Phone
E-mail
Please supply two references (dog trainers, Belgian owners, friends, neighbors, etc.—not including immediate family) who know you well enough to recommend you as a good dog owner.
Name
Address
Phone
E-mail
Relationship to you
Name
Address
Phone
E-mail
Relationship to you
By signing/submitting this questionnaire, I affirm that all statements made above are true to the best of my knowledge. (If you are submitting this form via e-mail, please type your name in the signature line. I will require a signed copy before placing a puppy.)
Name
Signature
Date
Name:
Address:
Home Phone:
Work Phone:
Cell Phone:
E-mail address:
GENERAL INFORMATION
Why do you want a dog?
Are you acquiring a dog for yourself or for someone else?
If for someone else, are they aware of your intentions, or is the dog to be a surprise?
Do you have children living with your or visiting regularly?
If yes, please note gender and ages.
Are you prepared to teach any resident or visiting children the proper way to conduct themselves around dogs?
How do others in your household (spouse/significant other, parents, children, etc.) feel about the addition of a Belgian Tervuren?
Who in your family will be primarily responsible for:
daily care of the dog
clean up
training
exercise
vet and food bills
How would you describe your household activity level?
Very quiet
Rather easygoing
Usually something going on
Lots of activity
How did you learn about Belgian Shepherds?
Why do you want a Belgian Tervuren?
Have you considered other breeds?
If yes, what breed(s) and why?
For each dog you currently own, please list the following:
Name – Breed or mix – Sex – Age – Is pet spayed or neutered?
For each dog you have owned in the past 10 years, please list the following:
Name – Breed or mix – Sex – Age – Was pet spayed or neutered? – Why do you no longer own the animal?
(If deceased, please give age at death and cause of death.)
Do you have other pets?
If yes, please list.
Do you regularly read any dog magazines?
If yes, please list.
Have you read any dog health or training books?
If yes, please list, and describe your general thoughts about these books?
Have you or anyone in your household ever been charged with animal cruelty?
If yes, please explain.
Have you or anyone in your household ever had any animal taken away for suspicion of animal cruelty?
If yes, please explain.
Have you or any person in your household ever had privileges suspended by the American Kennel Club, the United Kennel Club, the Canadian Kennel Club, or any other such club?
If yes, please explain.
LIVING ARRANGEMENTS
Do you live in:
apartment
house
mobile home
condo
other (describe)
In which type of area is your home located?
urban
suburban
rural
Do you own your home or are you renting?
Do you have a fenced yard?
If yes, size of yard, type and height of fencing.
If no, please explain what arrangements you will provide for housebreaking and for safe and adequate exercise.
Are there any dog restrictions or laws in your area?
Have you checked into local ordinances in your area pertaining to owning/housing an animal (e.g., leash laws, required vaccinations, dog licenses, etc.)?
Are you willing to comply with any such laws?
Have you ever used a crate in housetraining a puppy or dog?
Do you intend to use a crate for this dog?
If you have to be away from home for a few days and are unable to take the dog, what arrangements will you make to provide for his/her care?
What will you do with the dog when you go on a vacation trip?
In the event of emergency (e.g., hospitalization, natural disaster, etc.), who would take care of your dog?
If you were to move, what would happen to your dog?When you travel with the dog, where will he/she ride?
How do you envision a dog fitting into your home (schedule, indoor/outdoor activities, exercise, etc.)?
Where will the dog spend most of his/her time?
Where will the dog be when you are at home?
How long each day will the dog be alone?
Where will the dog be when you are away?
Where will the dog sleep?
YOUR INTERESTS/GOALS
Are you interested in a puppy, an older pup, or an adult dog?
Would you prefer to have a female or male dog?
Please describe any physical attributes that are of particular importance to you in the puppy/dog you are seeking at this time?
Are you prepared to spay/neuter your dog, or are you interested in breeding?
What are your goals for your dog? (Please check all that apply.)
Companion (pet) Conformation/Showing Agility Herding
Obedience Rally Tracking SAR
Therapy Dog Assistance Dog Messenger Dog Flyball
Schutzhund (Other (specify)
Please describe any character attributes which are of particular importance to you in the puppy/dog you are seeking at this time?
What do you expect of your Belgian?
What do you expect of your dog’s breeder?
GROOMING, EXERCISE, AND TRAINING
Are you aware of the grooming requirements of the Belgian Shepherd?
Are you prepared to spend the required time grooming your Belgian Shepherd?
In addition to the normal routine at home, what activities will your Belgian have?
Walk routinely with a family member
Go to classes
Compete in dog shows or performance events
Go to your place of business with you
Travel with you
Be a playmate for your children
Be a playmate/companion for other pets
Other (specify)
Do you belong to any dog or dog sports club(s)?
If yes, please list.
Have you ever trained a dog? Attended training classes?
If yes, please describe how you trained and what commands were taught.
How do you intend to obedience train your Belgian? (On your own? With a club/trainer? What commands will you teach and what training methods will you use?)
Are you aware of the SOCIALIZATION AND TRAINING requirements of the Belgian Shepherd?
Are you prepared to spend time SOCIALIZING AND TRAINING your Belgian Shepherd?
Have you ever experienced any behavior problems with past or present pets?
If yes, how did you handle those problems?
OTHER
Are you prepared for the responsibility of caring for this dog for its entire life (10-16 years)?
How did you learn about Genesis Belgians?
May I or my representative visit your home?
If no, why not?
Please add any additional information or thoughts that you feel would help me to understand you as a potential Belgian owner and the home you can offer the dog.
What questions do you have for me?
VETERINARIAN INFORMATION / REFERENCES
If you have a veterinarian, please provide contact information below
Name
Address
Phone
Please supply two references (dog trainers, Belgian owners, friends, neighbors, etc.—not including immediate family) who know you well enough to recommend you as a good dog owner.
Name
Address
Phone
Relationship to you
Name
Address
Phone
Relationship to you
By signing/submitting this questionnaire, I affirm that all statements made above are true to the best of my knowledge. (If you are submitting this form via e-mail, please type your name in the signature line. I will require a signed copy before placing a puppy.)
Name
Signature
Date
