First Name:
Last Name:
City & State:
E-mail address:
Phone number:
1.) Why have you decided to purchase a Great Dane?
2.) What breed(s) of dog have you owned in the past?
3.) Do you currently have any other pets? Yes No
> If yes, what types, ages and temperament?
> Are they spayed or neutered? Yes No
4.) Have you ever purchased a dog and then later sent it Yes No
> If yes, why?
5.) Have you ever had to put a pet down (euthanize)? Yes No
> If yes, please explain the reason:
6.) Do you currently have a veterinarian that you use? Yes No
> If you would like to offer your vet as a reference, please
Please describe your family and home...
7.) Number and ages of any children in your household? (If there are no children, do you have regular visitors who are (or
8.) Are all the members of your family in complete Yes No Not
> If "no" or "not sure", please explain:
9.) Do any members of your family have any known types Yes No Not
10.) Which best describes the area where you live?
Urban Suburban Rural
11.) Do you live in a: single family house, duplex, condo,
> Do you: Rent Own
> If you rent, have you checked with your landlord (and/or Yes No
12.) Do you have a completely fenced in yard? Yes No
> If yes, what type of fencing and how high is it?
> If no, where will your puppy be allowed to eliminate and
13.) Is a member of the family home throughout the day? Yes No
> If no, how many hours per day will the puppy/dog be left
> Where would the puppy/dog be housed during the day
Please describe what you are looking for in a Great Dane puppy...
14.) Why are you interested in purchasing a Great Dane? (You may select more than one)
Companion (family pet) Showing / possibly breeding
Obedience (competition) > If you selected "showing" do you Yes
Therapy dog / Service dog No
15.) Do you have a gender preference?
Male Female No preference
16.) Do you have a color preference?
Yes - please specify: No preference
> If your preferred color or sex is unavailable in the litter you Yes No
17.) Have you done your research and are you familiar with:
> The general care requirements of a Great Dane (both Yes No
> The potential health issues associated with Great Danes? Yes No
> The amount of attention, patience, training and love that is Yes No
18.) Are you willing to spend the time to properly socialize Yes No
> If no, please explain why not:
19.) Are you aware of the costs involved in properly raising a This includes not just the initial purchase price of a well-bred Yes No
> Is there any additional information that you would like to
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