New Family Application

"Properly trained, a man can be dog’s best friend." -Corey Ford

Placing a puppy into a family is one of the last steps we take in the bringing of happy, healthy canines into the world. Years of hard work have brought us to the place of being able to offer this puppy or litter for placement. We believe that each family that would be considered as a forever home for our puppies should be aware of the continued commitment that such a pup requires.
Please fill out the information listed below and return it for our consideration. This information allows us to get to know you as we work towards potential placement and is considered a critical element to finding the perfect puppy for your home.                

The information you share is voluntary and will not be disclosed to third parties. Please include photos if possible.

Thank you,    Charles and Christy Mikula.

HOUSEHOLD INFORMATION

1. Names/Ages of children:
2. Names/Occupation of adults in household:

3. Is everyone in the family in agreement about getting a new puppy?

PUPPY PREFERENCES

1. I would like a: ______Male ______Female ______Not sure.  
2. If you are getting two puppies, please indicate:  Same litter:  Y / N         Same Sex:  Y /  N
3. Keeping in mind that the Mikula’s do not place puppies based on color. The look I prefer in a pet including color would be:______________________________________________________________________________________________
4. Please describe the temperament you would like in a pup:_____________________________________________________________________________________________
5. Is there a date you have in mind to get a puppy?  ALSO, if you need the puppy shipped which airport would you use? _________________________________________________________________________________________________
6. Our pups are priced at different points depending on pedigree, etc.  Is there a price range/point you desire?        

PET HISTORY

1. Current dogs:_______________________________________________________________________________________
2. Recent Dogs:_______________________________________________________________________________________
3. Other animals? ___yes ___no      If yes, please describe_____________________________________________________
4. Have you ever owned a Golden before? ___yes ___no
5. Why did you choose this breed?________________________________________________________________________                                                                                                      

REFERENCES 

1. Do you have a regular vet? ___yes ___no
2. If so, would you mind if I contacted them? ___yes ___no
3. Name and Phone___________________________________________________________________________________
4. Could you list personal references not related to you or living in the same dwelling with you?
   Name_______________________________Relationship to you______________________________________________ Phone_____________________________________________________________________________________________

HOUSING INFORMATION

1. Do you own or rent your home?                                  [If you rent we will expect written permission from your landlord to keep a dog]
2. Size of living space:  Indoor:____________________________________________________________________________           What type of floors puppy will live on:____________________________________________________________________       
3. My outdoors are:     Fenced           Acreage        Small Yard      Subdivision      Farm/Ranch        Shared         
4. Will this puppy be primarily ___indoor ___outdoor
5. How many hours a day will you have for puppy?_____________________________________________________________
6. How often will you/do you walk your dog?_________________________________________________________________
7. Who will be the primary training / care giver for the puppy? ___________________________________________________
8. How do you plan on house and obedience training your puppy? ____________________________________________________________________________________________________
9. Is there a lifestyle or activities you would like a dog to fit into?________________________________________________________________________________________________
10. What will be puppy’s form of exercise: IE yard, walks, travel? _____________________________________________________________________________________________________
11. Where will this puppy sleep?_____________________________________________________________________________

GENERAL PROFILE INFORMATION: 

1.   How did you find us? Why are your considering us for your next companion? _____________________________________________________________________________________________________________________________________________________________________________________________________________

2.  Is there an interesting fact you would like to share about you/your family?                           ____________________________________________________________________________________________________________________________________________________________________________________________________________

3.  Do you have any specific needs or concerns?                                                                                                             ____________________________________________________________________________________________________________________________________________________________________________________________________________

PLEASE LIST ANY ADDITIONAL REQUESTS OR QUESTIONS BELOW THIS SPACE: