Kumakura Akitas

Ree & Keith Keca                                                                                                              16461 South Ellen Drive

815 439 6716                                                                                                                     Plainfield, Illinois  60544

 

PUPPY QUESTIONNAIRE

 

NAME(S) __________________________________________________________________________
ADDRESS _________________________________________________ EMAIL ____________

CITY ____________________________________  STATE _________  ZIP ____________
PHONE #'S- HOME__________________________ WORK ____________________________
BEST TIME(S) TO REACH YOU _________________________________________________
FAMILY DATA:   MARRIED   SINGLE   DIVORCED   LIVING TOGETHER

IF MARRIED OR LIVING TOGETHER DOES THE OTHER ADULT APPROVE OF GETTING THIS DOG? ________________________________________________________
_________________
YOUR AGE(S) __________________________
OCCUPATION(S) __________________________________________________________________
________________
CHILDREN IN HOUSEHOLD? ____________
AGES_________________________________________________
OTHERS IN THE HOUSEHOLD WHO WILL HAVE CONTACT WITH THIS DOG _________________________________________________________________________
WILL THE DOG COME IN CONTACT WITH CHILDREN OTHER THAN HOUSEHOLD CHILDREN? ______________
WHAT DOGS HAVE YOU PREVIOUSLY OWNED & FOR HOW LONG?  ___________________________________
__________________________________________________________________________________________________

DOGS PRESENT AT HOME NOW (BREED, AGE, SEX) __________________________________________________
__________________________________________________________________________________________________
ARE THEY SPAYED/NEUTERED?_______________________
OTHER PETS CURRENTLY OWNED _____________________________________________
______________________________________________________________________________
NAME OF YOUR VET _________________________________________________
PHONE NUMBER OF YOUR VET _______________________________________________
WHY ARE YOU INTERESTED IN OBTAINING ONE OF OUR AKITAS? _______________
______________________________________________________________________________________________________

ARE YOU FAMILIAR WITH THE CHARACTERISTICS & TEMPERAMENT OF THE AKITA?____________________
ARE YOU AWARE AKITAS AS A GENERAL RULE ARE DOG AGGRESSIVE?
_______________________________
WHAT QUALITIES DO YOU LIKE IN THE AKITA? ________________________________
______________________________________________________________________________
WHAT CHARACTERISTICS DON'T YOU WANT TO FIND IN AN AKITA? ______________________________________________________________________
______________
HAVE YOU EVER OWNED AN AKITA BEFORE?__________   IF YES,
EXPLAIN_____________________________________________________________________
__________________
ARE YOU COMMITTED TO CARING FOR THIS DOG FOR IT'S LIFETIME? ______________________
DO YOU HAVE A FENCED IN YARD?_______________
TYPE AND HEIGHT OF FENCE ____________________________________________________________
WHERE WILL THE DOG STAY DURING THE DAY?  __________________________________________
WHERE WILL THE DOG STAY DURING THE NIGHT?  _________________________________________
PUPPY/DOG INTERESTED IN PUPPY- MALE____ FEMALE____
WOULD YOU BE INTERESTED IN AN OLDER DOG- MALE____FEMALE____
HAVE YOU EVER RAISED A PUPPY BEFORE?__________________________________
WHO WILL HAVE PRIMARY RESPONSIBILITY FOR CARING AND TRAINING FOR THIS DOG? __________________________________________________________________
IF IT IS ONE OF THE CHILDREN, DOES THIS PERSON FULLY UNDERSTAND THE TIME & EFFORT REQUIRED TO PROPERLY CARE FOR AN AKITA?  __________________________________________

________________________________________________________________________________________
DO YOU FULLY UNDERSTAND THE TIME & EFFORT REQUIRED TO CARE FOR AN AKITA? ________________________________________________________________________________________
WOULD YOU BE WILLING TO UNDERTAKE JOB IF CHILD FAILS TO PERFORM JOB? _______________________________________________________________________________________
HAVE YOU EVER OBEDIENCE TRAINED A DOG? ________________________________
WOULD YOU BE WILLING TO OBEDIENCE TRAIN A DOG THAT YOU GOT FROM KUMAKURA AKITAS IF IT IS RECOMMENDED, OR REQUIRED, AS BEING IN THE BEST INTEREST OF THE DOG AND YOU? ______________
WOULD YOU BE WILLING TO ALLOW BREEDER TO VISIT YOUR HOME BY APPOINTMENT BOTH BEFORE AND AFTER YOU PURCHASED A DOG FROM US? ______________________________________

 

DOES YOUR HOMEOWNER’S INSURANCE BAN AKITAS?  _________________

Please add any other information you wish us to consider in placing one of our Akitas with you. We would appreciate it if you would give us a little insight into the expectations you may have for this new addition to you family.  Thank you again.  Your interest is deeply appreciated.

 

Signature:  ______________________________________________________      Date:  __________________________