Home Phone:       Mobile/Cell:                     Best time to call: 

Work Phone:            Home  Address:

City:   State:    Zip:   E-Mail

What is your occupation?

If you are married or live with a partner? YesNo           What is his/her occupation? 

Do you live in a:  House Townhouse Condo  Apartment

Are you aware of the municipal ordinance regarding the number of pets that may reside at your address?   
 Yes, I am aware of the limit for my area           No, but I will look into it

Will the addition of this puppy keep you within legal limits?    Yes    No

Number of Adults in household:    Number of children     Number of children part-time   

Ages of Children:  Is a new baby expected or planned within the next year?    Yes     No

What are your philosophies and general practices about children around, and interacting with dogs?

This will be my/our first dog: Yes    No        Is this your first Belgian?   Yes    No

If not, please list the names of Belgians you have previously owned or co-owned that live with you, the variety, the breeder(s) from
whom you obtained the dogs?

             Name       -                  Variety (Sheepdog, Tervuren , Malinois       -       Breeder(s)     
 

What do you think was the best trait of each of these Belgians?

What problems (health, training, behavior, etc.), if any, did you have with previous dogs of any breed?

 Why have you selected the Belgian Sheepdog breed to share your life and home?

How many individuals of this breed are you acquainted with?  
Please list the breed, gender and ages of any other pets (dogs, cats, etc.) that you presently own.

If you have owned dogs that no longer live with you, please list their breed(s), gender, age, and when they left your home what
happened to them, as best you can:

Is your yard fenced?  Yes  No

Please describe the fence and yard (i.e., the size, type and height of the fence, location in relation to the house, etc.  .

If you have photos, please attach:    

Will the dog receive the majority of his/her exercise in this yard?Yes No
If no, how/where do you plan to provide adequate exercise?

 Do you have a swimming pool on your property? Yes No    If yes, is it fenced, with type of fence?

On a typical day, how long are you away from home or how long will the dog be left alone? 
Where will the dog be while you are away during the day?

 Where will the dog sleep at night?

Will the dog spend the majority of his/her time  inside outside? 

Who will watch the dog when you go on vacation or if you become ill or need to be hospitalized?

 How often do you travel for business?  

How do other members of your family feel about this new addition?

Who will be the primary provider for this dog in terms of:  Feeding         Training

Exercise:     Grooming/bathing/nail care:

Food and Vet expenses:

What would you do if you had an unforeseen, very expensive medical emergency with your Belgian?  Would your Belgian get
treated no matter the cost?

Where will this dog ride while traveling with you in a vehicle?

Please indicate each of the training tools you will use with this puppy:
Buckle Collar  Head Halter  Choke/Metal Slip Collar  Pinch/Prong Collar  Electronic Collar  Bark Collar
Long Line  Leather Leash   No Leash   Flexi-Lead  Food  Clicker  Toys  Ear Pinch 

Other (Please explain below):

Please list any dog or dog-sport clubs to which you belong.

Have you ever used a dog crate?  Yes No  Do you plan to use a crate with this dog? YesNo

How do you plan to house-train this puppy?

Do you plan to train/show in the following, if yes to what level? No Plans

Conformation:YesNo          Train for fun            Compete: What level?

Agility:           YesNo           Train for fun            Compete: What level? 

Herding:         YesNo          Train for fun             Compete: What level?

Flyball:           YesNo          Train for fun              Compete: What level?

Tracking:       Yes No          Train for fun               Compete: What level?

Ring, SAR:    Yes No             Therapy Work:Yes No         

Other:

What titles have you earned with other dogs you have owned or trained?

 What type of training do you use?
Correction-based   Food-based   Purely positive   Clicker  Combination  

If you checked combination, please explain     

Other           

Please indicate each of the training tools you will use with this puppy:
Buckle Collar  Head Halter  Choke/Metal Slip Collar  Pinch/Prong Collar  Electronic Collar  Bark Collar
Long Line  Leather Leash   No Leash   Flexi-Lead  Food  Clicker  Toys  Ear Pinch 
 

Other (Please explain below):

Please list any dog or dog-sport clubs to which you belong.

Clinic:     
Address: 
City:        
 

State:      
Zip:         
Phone:     

Will you give him/her permission to discuss (in general terms) the care you have provided for animals
previously in your care?  Yes No

We sometimes have Belgian Tervuren in Belgian Sheepdog litters and vice versa. 
Would you consider a pet Tervuren?   Yes   No

While we all would like to have a “perfect” dog in every way, this is not realistic. We cannot tell everything that this puppy will
 grow up to be at this age, so your response here will help us to select between puppies with similar personalities. We all
 may prefer “moderate” across the board, but reality indicates that this is not always possible.  Please choose each personality
characteristic that you PREFER (can handle best) .

     With owner(s) Check all that apply                              With people the dog doesn't know  Check all that apply
Very social and in your face                                                   Very social and in your face
Very Friendly and very affectionate                                        Very Friendly and very affectionate
Friendly and affectionate                                                        Friendly and affectionate
Social                                                                                    Social
Mellow                                                                                 Mellow
Softer, more submissive                                                         Softer, more submissive
Shadow-like (follows you everywhere)                                   Aloof
Aloof                                                                                     Highly protective of family
Aloof and doesn't require much affection                                Trustful of everyone, not protective
Independent - doesn't need you for much                                Assertive (in your face)                                                           
Stronger, more challenging, domjnant

Training  Check all that apply                                                                  Other  Check and fill in   

High energy/drive                                                                            
Low energy                                                                                    
Willing to please                                                                              
Learns quickly but frequently makes mistakes                                   
Learns at slower pace, and rarely makes mistakes                            
Has high herding tendencies                                                              
Has moderate to little herding tendencies
Dominant
Submissive/soft

Please describe YOUR “ideal” temperament and personality.  Use as many adjectives as possible.

When we sell a dog for companionship only, he will receive his AKC registration as usual. However, we will designate that the dog's
registration is Limited.  This means that the dog is registered and can be shown in all venues such as,  Obedience, Rally, Agility,
Tracking, and Herding, except for the show ring (conformation).

This also means that offspring from this dog cannot ever be registered with the AKC.  The breeder is the only one who can change
this designation.  This protects our non-breeding dogs from being bred.  Are you willing to accept this policy  regarding the sale of
companions only?  Yes  No  If no, please explain why:


I will spay/neuter  I will not spay/neuter  Please explain:

There is a clause in our contract that states that if at any time you can not keep or care for this dog, he/she cannot be given away
or resold or go live with someone else in a co-ownership.  Do you agree to this? YesNo

What do you expect from your dog’s breeder? Please elaborate.

May we visit your home, or designate someone to visit your home?  YesNo

How, or from whom did you learn about us and this litter?

Are you currently on any other waiting lists, or do you have a deposit on a puppy from another litter?

Waiting List: YesNo               Deposit:  Yes No

Please provide three references that would have good knowledge of your responsible dog ownership.  This may include dog
trainers, Belgian Sheepdog owners whom you know, other dog owners who know you, your veterinarian, or neighbors.
Insert Name, Address, City, State, Telephone Number and E-mail address.

                                                      Referral 1                                                                  Referral 2

                                                                              Referral 3

If you are considering breeding:  Have you bred in the past?   Yes   No 

If yes, how many litters have you bred in how many years?  Litters  

Years 

What Breed(s)?

If you are considering breeding, what are your reasons for breeding?

Please rank the following 14 points of conformation in order of importance to you either for your goals in conformation, performance
activities, or just personal preference.  Place a “1” next to the most important, and “2” next to the next important, and so on.

Head,   Ear Set,      Ear size,    Shoulder Assembly,    Topline/back,   Front,

Rear, Movement, Coming,   Movement, Going,  Side Gait,     Color, 

Length & Arch of Neck,  Length of Hock,   Length of Pastern,  Length of Back,

  Feet,    Height/Size,   Dentition,    Length of Tail,

Other.

Please describe any physical attributes that are of particular importance that you want or don’t want in this puppy.  Please be as
detailed as possible.

Do you belong to the Belgian Sheepdog Club of America? Yes No      If not, do you plan to join?   Yes  No