Please click HERE for an electronic application
In order for us to help you select the “right” dog for your specific needs
PLEASE ANSWER THE FOLLOWING QUESTIONS THE BEST YOU CAN
Although these questions may seem personal they are important.
Circle all that apply, print clearly, Thank You.
1) a: I would like a A) male B) female
b: I prefer (please circle one) A) Plush coat (long haired) B) smooth coat (short haired)
2) The temperament I expect from my dog, as per the following possibilities would be:
The mailman knocks at the door with a package delivery, I want my dog to:
A) bark, then make friends B) bark, then chew him up
C) bark, and not make friends D) other: _______________________
My dog and I are taking a walk in the park and I see some old friends. I want my dog to:
A) wag his tail B) attack them
C) ignore them D) other: _______________________
3) My dog will spend most of his time:
A) in the house B) in a kennel run C) running loose
D) in the fenced yard E) on a chain F) other: __________
4) I am interested in training my dog in:
A) obedience B) search & rescue/herding C) Schutzhund
D) agility E) therapy/seeing eye F) other: __________
5) I am interested in show and/or breeding: YES NO
6) I am interested in a pet & plan to spay/neuter. YES NO
7) I have owned _____ dogs in the past _____ years.
8) My dogs were:
A) given away B) euthanized because ___________ C) other: __________
D) killed in accidents E) died of old age
9) My household consist of _______ dogs, (please list age, breed and sex):
___________________________________________________________________
___________________________________________________________________
10) My household consists of:
_____________ adults, __________children (ages) _____________________
_____________ cats, __________birds (type) _______________________
other: ______________________________________________________________
11) Do you expect to have children? YES NO
12) The adults in my household are: 0-20 20-30 30-4 40-50 50-60 60 & up
13) Please supply two references and contact numbers: ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
14) Any comments you may have that may help us choose the correct temperament pup
for you (ie. Lifestyle: runner, hiker, etc) would be appreciated
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Name: __________________________________________________________________
Address: ________________________________________________________________
City: __________________________ Province: _____________ Postal Code: ________
Home Phone: (___)-___-____ Work: (___)-___- ____ E-mail: ____________________
Thank you for your cooperation.
** any other questions or comments you might have please use back of this page, or E-mail us at
michelle@genesisshilohs.com or phone us at (613) 477-1844
