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| First Name | |
| Last Name | |
| Address Line 1 | |
| Address Line 2 | |
| City | |
| State | |
| Zip Code | |
| Country | |
| Daytime Phone | () - |
| Evening Phone | () - |
| E-mail Address | |
| Are you interested in a GSP, a Weim, or either/both? | |
| Reason for wanting a dog | |
| Are you looking for a male or female? Why? | |
| If you are looking for a GSP, do you have a color preference? | |
| What are your interests with this dog? Conformation, hunting, obedience, agility, pet | |
| If you get a show quality puppy, are you willing to show it or have me show it for you? | |
| If you get a companion dog, are you willing to sign a spay/neuter contract? If no, why not? | |
| Have you ever put a title on a dog before? If so, what was the title? | |
| Have you owned a GSP or Weimaraner before? If so, do you still own, why or why not? | |
| If you have owned a GSP or Weimaraner before, where did you acquire the dog? Include breeder's name if possible. | |
| Have you ever surrendered a pet before? If yes, please explain why | |
| Do you own other dogs? Please list breeds. Other pets? Cats? | |
| Are you willing to travel to get your dog and how far? | |
| When are you looking to add a dog to your family? | |
| Other members in household, particularily children and ages | |
| Who will be the primary caretaker of the dog? | |
| Will someone be home during the day? If not, are you willing to take the dog to daycare? | |
| Where will the dog be when left alone and for how long on average? | |
| Where will the dog live? Sleep? | |
| Are you willing to crate train? | |
| Are you willing to take the puppy to obedience classes? | |
| Do you rent or own? | |
| If you rent, may we have contact information for your landlord? | |
| Do you have a yard? If so, how high is the fence and what type of fence? | |
| Current or prior veterinarian for reference | |
| Will you deal with health issues should the dog need special care later in life? What would you consider the limitations to be? | |
| What would you consider to be a major medical expense? Understand the average lifespan of these dogs is 12 to 14 years. | |
| Do you intend to be a single or multiple dog household? | |
| Do you understand and agree that if at anytime you are unable or unwilling to keep this dog, the dog is to be returned to me as the breeder? | |
| How did you hear about us? | |
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