QUESTIONAIRE GENERAL
1. How many people reside in your household and how old are they?
2. What are your hours of work?
3. Does anyone in your family have allergies associatied with animals?
4. When is the best time to reach you by phone?
5. Does your spouse agree to your family adopting a Pug?
6. Supply two people for references not a relative or someone living with you.
7. Where did you hear about Lyntom Pugs?
HOME LIFE
1. Do you live in the country or the city?
2. How long have you lived at your current address?
3. Do you have any body of water (pool, pond, etc.) that a dog would have access to?
4. Do you have a fenced yard?
5. Do you have air conditioning?
6. Do you have written permission from your Landlord to have Pugs?
7. Do you have raised areas (balcony, deck, etc,) that be a fall hazard to your new Pug?
PET EXPERIENCE
1. What pets do you currently own? Please list.
2. Are your present pets current on vaccinations?
3. What is the name of the Veterinary Clinic you deal with?
4. Are you willing to house train your new Pug?
5. Please list the Dog Clubs to which are now or have been a member of.
6. Are you willing to enter into a spay/neuter agreeement?
7. Have you ever lost a pet?
BREEDERS SECTION
1. Are you interested in breeding Pugs for hobby, sport or income?
2. What is your goal in breeding Pugs?
3. Please list the Dog Clubs to which are now or have been a member along with the dates of your
membership.
4. Have you ever been suspended by the CKC or any other Dog Club?
5. Are your present dogs current on vaccinations?
6. Have you surrendered a dog to animal welfare or returned one to a breeder?
7. Have you ever had a dog euthanized? If yes, for what reason?
THE PERFECT PUG FOR YOU
1. What colour Pug are you looking for? Show Prospect or Companion Pet?
2. What age?
3. Male or Female?
4. Will you accept a Pug of the opposite sex, if your first choice is not available?
5. Where will your new Pug sleep? Your bed, Crate, etc.?
6. Who will be the primary caregiver to the Pug?
7. How long will your new Pug be left unattended during the day?
8. Are you willing to return the Pug to the breeder should some unforseen circumstance arise and you were
unable to keep your Pug in accordance with the contract or any other reason?
9. Do you agree to care for your Pug in the form of regular nail trimming, cleaning of ears, eyes and noseroll?
10. Are you willing to accept full financial responsibility for all Verterinary care and costs for your Pug once
you have adopted?
I agree by signing this document that I fully understood and have answered all applicable questions on pages 1 &
2, and certify that the information supplied is correct to best of my knowledge.
Signed
Date
