(Fields marked with an * are required fields.)

*Name(s):

*Address:

*City:    *State:    *Zip Code:

*E-mail:

*Daytime Phone:    *Evening Phone:

Children(age/sex of each):

Note: please include same information for grandchildren, etc., who visit frequently, and identify them as part-timers.

Adult Age Group: 18-21  22-26  26-35  36-45  46-55  56-64  66-75  Over 75

Why do you want a Newfoundland Dog?

Feeding, grooming, heartworm medication, and veterinary care for a Newfoundland may cost more than $1000 a year. Are you prepared to allot this much of your household budget for the care of a dog?   Yes  No

WHAT DO YOU WANT IN A DOG? (check all that apply)

1. Sex:(all will be neutered/spayed)  Male  Female  No preference
2. Age:   Older puppy  Young adult 1-3 years  Adult 4-6 years  Older dog  No preference
3. What do you plan to do with the dog?  Companion  Pet obedience class  Pet therapy  Water dog  Draft dog  Agility  Running/walking companion  Competition obedience  Other, specify
4. Do you have any special requests for personality, color, etc.?

PET OWNER HISTORY

1. Do you have other pets in the household at this time? (age, sex, species, breed, spayed or neutered

2. Tell us about other pets you have owned and why you no longer have them.

3. Have you ever lived with a Newfoundland before?  Yes  No

   Any other large breed?  Yes, specify  No

4. Where did you first hear about this breed? What books have you used to learn more?

5. Have you talked with any Newfoundland owners or breeders?  Yes  No

   Were you able to observe their dogs(s)?  Yes  No

6. Have you ever taken a dog through basic obedience class or have you used books or video tapes to accomplish the same level of training at home? Why or why not?

YOUR ENVIRONMENT AND OTHER PERTINENT TOPICS

1. Do have you a fenced yard or a fenced dog pen?  Yes  No

   If not, describe the measures you plan to use to assure exercise and toileting?

2. If you do not own your home or live in an apartment/condominium/townhouse development, do you have written consent to have a pet or an additional pet in the home?  Yes  No

   Please provide the name and phone number of the individual with whom we can verify.

3. Describe the setting you live:   Large city  Medium city  Small town  Dense suburb  Far suburb  Rural  Farm
4. Is there an adult in the home during the day?  Yes  No

   During school vacations if there are children?  Yes  No

5. Are there any members of the family with special needs in selecting the dog, such as mobility impairment, hearing impairment, visual impairment, learning/education limitations or psychological difficulties?  Yes  No
6. What are your present plans for the care of the dog while you are on vacation or out of town for other purposes?  Petsitter service  Neighbor/friend/family member  Board at kennel or vet  Will go with us when possible
7. Are you willing to provide (class or other source) basic obedience training? If not, how do you plan to train the dog to your "house rules?"  Yes  No

   If not, how do you plan to train the dog to your "house rules?"

8. Where will the dog spend the hours when no one is home?

9. Where will the dog spend those hours when folks are home?

10. Where do you plan for the dog to sleep?

11. Where will the dog ride in your vehicle(s)? What form of restraint will be used (crate, seat belt, harness, etc.)?

DOGS WITH SPECIAL NEEDS

Would you accept a dog with any of the following limitations or problems?

1. Minor, short-term health problems (ear or skin infections):  Yes  No
2. Known hip dysplasia, not causing pain or limitations at present:  Yes  No
3. Known seasonal allergy (flea bite, some grasses):  Yes  No
4. Chronic illness but low-cost to manage:  Yes  No
5. Unable to cope with children in the household:  Yes  No
6. Needs longer term psychological/social support to overcome:  Yes  No
7. Fear due to physical/psychological abuse:  Yes  No
8. Fear due to poor socialization to the community outside the home and yard:  Yes  No
9. Needs complete house training, not just potty training (due to whole life in kennel):  Yes  No
10. Absolutely must have obedience training:  Yes  No
11. Visible scars or limp due to injury (may be physically limited):  Yes  No

FUTURE CONSIDERATIONS

1. Are you willing to have a visit from someone familiar with placing rescued dogs in new homes or another Newfoundland owner prior to receiving a dog from OWNC?  Yes  No
2. Are you willing to have one or more visits from a person similiar to that above after you have received a dog form OWNC? (Appointment only and not always done)  Yes  No
3. Are you willing, if such a post placement visit is not possible to maintain close contact by phone or mail with a representative of OWNC or a nearby owner or breeder, to assist in interpreting the behavior of the dog, advising on training issues and general aspects of helping both you and the dog adjust? (Support from OWNC is not limited to the adjustment period. It will always be available to you.)  Yes  No
4. Are you willing to give OWNC an annual update and a recent snapshop of the dog, for the rest of its life and notify us of any address changes? (letter or short note)  Yes  No
5. Will you agree to notify us whenever the Newfoundland is lost, when it dies or if for any reason you feel that you cannot keep the dog? (OWNC will always take a Newfoundland back if you are not able to keep it for any reason.)  Yes  No

References (Please add any other references you would like us to contact.)

1. Veterinarian:   
   Phone number:
2. Breeder:   
   Phone number:
3. Dog Club:   
   Phone number:
4. Other reference:   
   Phone number:

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