Date *
Email *
Home Phone *
Other Phone
Best time to contact you *
How did you hear about us?
Have you ever raised a puppy, Leo or other, before? Yes No
Why do you want a puppy from our breeding program?
Do you own or rent your home? Own Rent
If you rent, do you have your landlord’s permission to own a large dog? Yes No I am not sure
Please provide the name and contact information for your landlord:
Please give a brief description of the type of home you live in and your property:
Please give a brief description of your fencing and if it completely encloses your yard:
If no fence is currently in existence, please describe how you plan to handle your dogs’ potty duties and exercise time:
Are you aware that it could take up to a year to have a perfectly house trained puppy? No, I did not realize Yes
Do you have a pool? Yes No
Is it fenced? Yes No
Please give a brief description of your household: names, ages and relationship to you:
Who will have the primary responsibility of caring for the puppy?
Does everyone in the home want a new puppy? Yes No
Are you aware of anyone in the family that has pet allergies? Yes No
If so how do you plan to deal with this?
If you have children are you willing to teach your children how to handle a rambunctious puppy in a proper manner and supervise their interactions? Yes No Third Choice
Are you and your family willing to take your new puppy to “Puppy Obedience” classes? If not, please describe your reservations:
What are your biggest concerns in getting a new Leonberger puppy?
Are you aware that the average lifespan of a Leonberger is 8-10 years? Yes No
Are you willing to commit to this dog for its entire lifetime? Yes No
Leos are a double coated breed and shed profusely. They need to be completely brushed at least once a week and groomed on a regular basis. Are you aware of these requirements and willing to maintain this type of grooming regimen? Yes No Not sure I have time
As a part of our contract we are guaranteed the “First right of refusal”, on all our puppies, are you aware of this clause? Yes No
Our commitment to producing healthy pups demands that we collect genetic information from all pups of our breeding. For this reason, we require that all of our pups be tested for genetic diseases between 24 and 30 months of age at the owner's expense. This testing provides important health information to owners and includes OFA elbow and OFA or PennHip hip X-rays. Depending upon where you live, these tests will cost approximately $300. Are you willing to have these tests completed and provide us with the results? Yes Not able to
How many animals have you owned in the past 10 years?
Please list the names, breeds and any other pertinent info of each one:
If any of the above named animals are no longer with you, please explain their current existence:
Have you ever had to give an animal away? * Yes No
If you have given an animal away, what were the conditions and where did the animal go; return to a breeder or turn it in to a shelter?
Barring serious behavioral problems, are you willing to wait until your pup is over 18 months of age and, if female, has had at least one season, before spaying or neutering? Yes No
If you are purchasing this puppy as a breeding prospect, tell us about your breeding plans and program, past, present and future?
Describe your perfect Leonberger:
What are your plans for housing your Leo while you are away?
What are you plans for housing your Leo at night-time?
Where will your puppy/dog be when you are home?
Do you prefer a Male or a Female or either? Male Female Either
How would you describe the personality or specific traits you are looking for in your new dog? (Please be specific about energy level, drives, confidence, dominance/submission, water work, eye contact, intelligence, learning style, professional cuddler, appearance and anything else that is important to you in your dog.)
Do you agree to license your dog and give it regular and possibly specialty veterinary care (OFA Hip x-rays before serious competition or breeding; annual eye checks, genetic tests, etc. as necessary) and vaccinations in accordance with your local laws? Yes No
Is the cost of this kind of care going to be a financial strain? Yes No
Do you understand that we will select the puppy for you and that matches will not be made until structure and temperament evaluations have taken place after the puppies are 7 weeks old? Yes No
Are you aware of some of the health problems that can occur in Leonbergers, such as genetic disorders, medication sensitivities and the like? Yes No
Would you like to discuss these further with us? No, I am good Yes, please
Do you have a regular veterinarian that you use? (We’ll ask for his/her address and contact info. below) Yes No
Are you on any other breeders’ puppy lists? No, just yours Yes Third Choice
If so, whose?
When is that litter due?
Do you agree that if you can no longer keep the dog and need to find it a new home that you will contact us first? Yes No
We do not ship puppies as freight so new owners must pick up their puppy themselves, whether driving or flying. This is a great opportunity for you to meet us and our dogs and for us to meet you. Do you understand and agree? Yes No
We also ask each owner to participate in the University of Pennsylvania’s Canine Behavioral Assessment Research Questionnaire C-BARQ (http://vetapps.vet.upenn.edu/cbarq/). There is no cost to this participation but it requires completing a 10-15 minute on-line questionnaire. We also send out a short health survey via Survey Monkey annually. Are you willing to participate in our C-BARQ program and health survey? Yes No
Do you certify that all of the information that you have provided in this questionnaire is true and complete to the best of your knowledge and belief. Do you understand that falsifying answers on this questionnaire or at any other time during the application process will disqualify you from getting any animal from Caprock Leonbergers? Yes No
If you understand the above statement, please type/sign your name and the date here:
Reference 1 - Relationship to you
Reference 1 - Address
Reference 1 - Email
Reference 1 - Phone
Reference 2 - Relationship to you
Reference 2 - Address
reference 2 - Email
Reference 2 - Phone
Vet Address
Vet Email
Vet Phone
Now that you made it to the end (Whew!) Are there any questions that you would like to ask us?
