GaiaBelgianTervurens 12165OldHwy75 Okmulgee,OK74447

Tel:9182005645 Fax:4407560995

GaiaBelgianTervurens
PuppyBuyerSurvey
ThankyouforyourinterestinaGaiaBelgianTervurenpuppy.Toassistmeinplacingeachof mypuppiesintherighthome,wewouldlikeyoutocompleteandreturnthefollowingsurvey. Therearenorightorwronganswers!!!Please,dofeelfreetoelaborateasyoufeelnecessary. Thepurposeofthissurveyissowecanbetterunderstandwhichpuppywouldbestworkfor youandyourparticularhome.Byfranklyansweringthesequestionsyouwillenablemeto makethebestpossiblematchbetweenpuppyandnewownersaspossible. IMPORTANT! Areyouwillingtotrustmetopickoutthepuppythatfitsyourfamilyandlifestyle basedontemperamentratherthangenderorappearance? Pleasecircleone:YESNO 1) WhatattractedyoutotheBelgianTervuren?Wheredidyoufirstseeone? 2) HaveyoueverownedanBelgianTervurenbefore?Anydog?Ifso,pleaseelaborate. Wheredidyougetyourdogs,theirages(andifdeceased,pleaselisttheageandcauseof death),etc.

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3) Doyoucurrentlyhaveanyotherpets?Pleaseelaborate 4) Doyouhavechildrenathomeorasregularvisitors?Ifyes,pleaselisttheiragesandnames 5) Doyouhaveapreferenceregardingthesexofyourprospectivedog?Ifyes,please elaborate(Iwouldpreferafemalebecause.) 6) DoyouintendtoparticipateinanyofthefollowingactivitieswithyourBelgian? []conformationshowing[]obedience[]agility []herding[]tracking[]SAR[]other 7) HowdoyouintendtotrainyourBelgian?Onyourownorwithaclub/andortrainer? Pleaseelaborate. 8) Doyoubelongtoanydogordogtrainingclubs? 9) Haveyoureadanydogtrainingbooks?Ifyes,pleaselistthemalongwithyouropinion/and orreactions. 10) Doyou,oranyofyourcloseneighbors,ownlivestock?Ifso,whattypesoflivestock,how manyandhowclosetoyourhomearethey? Page2of6

11) HowdoyouimagineyourBelgianfittingintoyourhousehold? Approximateschedule,indoor/outdoordog,kidsdog,activitiesandexercise.Please elaborateasnecessary. 12) Howlongeachdaywillthedogbealone? 13) Wherewillyourdogbewhileyoureawayfortheday(oratwork?) 14) Wherewillyourdogsleep? 15) Whoinyourfamilywillbeprimarilyresponsiblefor: dailycareofthedog/feeding:_____________________________ grooming:_____________________________________________ cleanup:______________________________________________ training:_______________________________________________ exercise:______________________________________________ veterinary&foodbills:___________________________________ 16) Whowouldtakecareofyourdogifyou(ortheprimarycaregiver)hadtobehospitalized? 17) Whatwillyoudowithyourdogwhenyougoonvacation? 18) Whenyoutravelwithyourdog,wherewillitride? Page3of6

19) Haveyoueverusedacrateforhousetrainingapuppyordog?[]Yes[]No 20) Doyouintendtouseacrateforhousetrainingyourpup?[]Yes[]No 21) Ifyouarecurrentlyrentingyourhome,doesyourlease/landlordallowpets/dogs? 22) Doyouhaveafencedyard?Ifyes,pleasedescribe(sizeofyard,typeandheightoffence) 23) Doestheareainwhichyoulivehavedoglimits?Ifyes,whataretherestrictions? 24) Whichveterinarianwillyouuse?Pleaseprovidehis/hername,clinicname,addressand phonenumber. 25) WhatdoyouexpectofyournewBelgianTervuren? 26) Whatdoyouexpectofyourdogsbreeder(s)? 27) WouldyouliketobreedyourBelgianTervuren?Pleaseelaborate Page4of6

28) MaythisbreederoralocalABTCmember(AmericanBelgianTervurenClub),orother specifiedindividual,onbehalfofthisbreeder,visityourhome? []Yes[]No 29) Arethereanyspecificphysicalorcharacterattributeswhichareofparamountimportantin thepuppyyouarecurrentlyseeking? 30) HowdidyoufindGaiaBelgianTervurens? References: Wenotonlyasktodoahomecheck,butwealsorequestthatyouprovidemewiththree(3) referenceswhichwouldhavegoodknowledgeofyourabilitytobearesponsibledogowner. Thesemayincludedogtrainers,Belgianowners,veterinarian,friendsandneighbors(sorry, familymembersareexcluded). Name: Address: Phone: Email: Relationshiptoyou: Name: Address: Phone: Email: Relationshiptoyou: Page5of6

Name: Address: Phone: Email: Relationshiptoyou: Iswearthattheinformationinthissurveyistrueandcompletetothebestofmyknowledge: YourSignature_______________________________________________ Date:_____________ YourName/Address/PhoneandEmail: Whatquestionsdoyouhaveforme?? Thankyoufortakingthetimetofilloutthislengthysurvey. Imakeeveryefforttoplacemypuppiesinresponsible,lovingandlifelonghomesaccordingto theneedsofboththepuppyandnewowners. Iwillcontactyoushortly! Page6of6