If I do not have the puppy you want do I have your permission to forward your questionnaire to a breeder who might? *	Yes No Ask me first
Referred by
First Name *
Last Name *
Primary Email *
Address *
City *
State *	AL AK AR AZ CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Country *	Abkhazia Afghanistan Aland Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Argentina Armenia Aruba United Kingdom Ascension Island Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Guyana Haiti Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Transnistria Pridnestrovie Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
Years at this address? *
Residence *	Single Family Two Family Apt/Condo Farm Trailer Other
If other what type *
Home Phone *
Work Phone
Cell Phone
Are you willing to permit a home check? *	Yes No
Do you have a fenced yard? *	Yes No
If so, please describe.
Are you married? *	Yes No
Do you have children? *	Yes No
If you have children please list how many and their ages.
Does anyone have allergies?	Yes No
If yes, who, to what and how severe?
Is everyone in your family completely committed to getting a Great Dane? *	Yes No
Have you considered rescuing an older puppy or adult? *	Yes No Have previously adopted a rescue.
Do you currently own dogs? *	Yes No
If Yes, How many, breed, sex, and age of dog(s)
Are they spayed or neutered? *	Yes No Not All
If No, why not? *
Have you had dogs before? *	Yes No
If Yes, What breed(s)?
If Yes, what happened to them?
Do you have any other animals? *	Yes No
If Yes, What type?
Have you ever given a pet away? *	Yes No
If so, what were the circumstances?
Why do you want a dog? *
Why are you interested in Great Danes? *
Are you willing to travel for your new puppy?	Yes No Depends on distance
How familiar are you with Great Danes? *
Are you aware of the yearly costs of maintaining a healthy dog? *	Yes No
Veterinarian (name, address & complete phone number) *
24 Hour Emergency Facility (name, address and complete phone number) *
Do you have a preference about male or female dog?	Male Female No Preference
If your puppy is to be a pet are you willing to spay/neuter? *	Yes No
If your puppy is a pet are you willing to work with your breeder regarding the appropriate age to spay or neuter? *	Yes No
Why do you prefer the gender that you do? *
Do you have a color preference? *	Black Blue Brindle Fawn Harlequin Mantle Merle No preference
Do you have a preference for cropped or uncropped ears? *	Cropped Uncropped No Preference
Are you willing to consider the opposite ear style you chose above? *	Yes No
Are you willing to work with your breeder regarding aftercare and taping of cropped ears *	Yes No Not Applicable
Are you willing to work with your breeder regarding feeding and vaccination protocols? *	Yes No
Are you willing to travel to pick up dog? *	Yes No
Are you interested in showing in the conformation ring? *	Yes No
Have you ever shown a dog to it's championship? *	Yes No
Are you interested in competition in performance events such as obedience, agility, hunting, herding, etc.? *	Yes No
Have you shown a dog to any performance titles? *	Yes No
Who will be primary caregiver? *
How many hours will the dog be left alone per day? *
Where will dog stay when alone? *
What kind of floor surfaces will the dog be on in the house? *
Does your family travel? *	Yes No
Where will the puppy/dog be kept during the night? *
Where will the puppy/dog be kept during the day? *
Is anyone home during the day, and if so, who? *