Name:    
                    City:    
                    State:   
                    Email:   
                    Phone:   
                    URL:     
                    Have you ever owned a German Shepherd before?
                     Yes
                     No
                    If Yes, please tell us about them.
                    Name:    
                    Age:     
                     Male
                     Female
                    Please check all that apply to the dog.
                     Living
                     Deceased
                     Sold
                    If sold, please give us a brief comment as
                     to the conditions that led to the sale.


                    Comments:
                    
                    Do you presently own any dogs?
                     Yes
                     No
                    What are your plans for this dog? (Check all that apply)
                     Family Companion
                     Breeding
                     Show
                     Sport
                     Schutzhund
                     Therapy
                     SAR
                     Service
                    Do you own or rent your home?
                     Own
                     Rent
                    Do you live in a...
                     House
                     Apartment
                     Condo
                    Do you have a fenced yard?
                     Yes
                     No
                    Do you have children?
                     Yes
                     No
                    If so, what are their ages?
                    Ages:     
                    Number of hours a day the dog will be at home alone?
                     Someone usually home
                     1-3
                     3-6
                     6-8
                     More
                    Have you ever relinquished a pet to the pound 
                    or had it euthanized for something other
                     than an extreme medical problem?
                     Yes
                     No
                    What budget are you working with for the purchase of your new
                     puppy/dog?
                    Budget Amount:   
                    What sex do you prefer?
                     Male
                     Female
                     Either one
                    How did you hear about us?
                    Anything else you would like to tell us 
                    about yourself, your lifestyle, your family, etc...
                    Comments: