The following questions are being asked of you so that the right puppy and the right placement of each puppy is made by bringing the various requirements of both the puppy and his or her new owner(s) into perspective, BEFORE a choice is made. I hope you will agree that the animal's welfare must be our foremost consideration in considering a placement. Please answer the following questions as completely as you can, and return this form when you've finished.

Please print clearly :
•Name:_______________________________________________________________ ______                                                                         Date: ____________________     


•Phone:_________________________      Email:_____________________________________

•Referred by or website:________________________________________________________

•Type of dwelling:      house      condo      apartment      mobile home    duplex or other 

•If renting, do you have permission from landlord to own a pet?  Y or N  

•If renting, please give name, phone and address of landlord. __________________________________________________________________________________________________________________________________________________________________________

(I do require a signed statement from your landlord before the puppy can leave my care)

•Do you currently use a veterinarian?  Y or N

•If yes, Name of Vet, address and phone:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

1. Where will the puppy be kept during the night? ____________________________________________

2. Where will the puppy be kept during the day? ______________________________________________

3. Is anyone home during the day? _______________________________________________________

4. How many hours on the average will the puppy be left alone? _______________________________

5. Will there be someone available to feed and exercise the puppy during the day?  Y or N

6. Have you ever owned a dog before?  Y or N   

7. Do you have any other animals in the house? If yes, how many and what?_____________________________________________________________________________________________________________________________________________________________________

8. Do you have any children under 7 years old  ?  Y or N

9. Are you interested in a male or female puppy?  M or F

10. How did you hear about this breed? __________________________________________________

11. Do you understand Pomeranians are house dogs not outside dogs ? ____________________________________

12. Do you have a fenced yard ? Y or N  If so how high is the fence? __________________

13. Will you be attending any training classes? Y or N

14. Have you ever returned a pet to the breeder or rescue? _____________________________________   If so, what were the circumstances? ______________________________________________________

15. Have you ever given a pet away? Y or N   If so, what were the circumstances? __________________________________________________________________________________________________________________________________________________________________________

16. Have you ever taken a pet to a pound or shelter? Y or N      If so, what were the circumstances? __________________________________________________________________________________________________________________________________________________________________________

17. Are you interested in showing the dog in any competitions? Y or N

18. Do you intend to breed the dog? Y or N  

19. Do you understand the difference between a limited AKC registration and a full AKC registration? Pet Only is no papers Y or N

20. Have you ever owned a Pomeranian ? Y or N   If so, what is your experience with them?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

21. Does the prospective owner agree to the terms of the contract including the spay/neuter clause on pet quality puppies? Y or N

22. Does anyone in your household have allergies to animals? Y or N

23. What do you expect the activity level of this breed to be? very high    high     moderate     below average

24. If you have never owned a Pomeranian, what made you consider this breed? ____________________________________________________________________________________________________________________________________________________________________

25. Are you prepared to provide for this Pomeranian for his/her entire life (Pomeranians can live 14+ years)? Y or N

26. Do you foresee any problems in meeting all of the terms in the spay and neuter agreement? Y or N

Please be sure you are prepared to uphold this agreement, as I do stand behind my agreement 100% and will fully enforce it.

27. Do you have any Questions or Comments for us?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



References (two please)



Phone Number:




Phone Number:

Sign and Date and return to My StarPomeranians : ----------------        -----------------