Kohana Reg'd Golden Retrievers' Online Puppy Application
Welcome to Kohana Goldens Online Puppy Application. This application is your first step at becoming the home of one of our precious new puppies (or placeable adults, if one is available). From here, it is best to send us a quick email to let us know that you've filled out the application, as there have been instances where applications have mistakenly ended up in our "Junk" folder. By filling out the following application, it neither entitles you to a Kohana puppy, nor is it a commitment on your part to accept a Kohana puppy. Thank you in advance for your interest.
Name
*
First Name
Last Name
Spouse's Name
Spouse's First Name
Spouse's Last Name
Occupation
*
Spouse's Occupation
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
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
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
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
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
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
Martinique
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
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
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
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
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
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone Number
*
-
Area Code
Phone Number
E-mail
*
How did you hear about Kohana?
*
Please Select
Another Breeder
Vet Reccomendation
Internet Search
Know/Met Another Kohana Puppy
Other (Please Specify)
Other (If Applicable)
If you met another Kohana puppy, who was it?
Why did you decide to welcome a Golden Retriever into your home?
*
Do you have, or currently plan to have children?
*
Please Select
Yes, I/we currently have children
No, but I/we plan to have children within the next 2 years
No, but I/we plan to have children sometime in the future
No, I/we dont currently plan to have children
In the event that you currently have children, please list their ages.
Which of the following statements best describes the general activity level of your home?
*
Please Select
Generally very active
Generally moderately active
Generally quiet
Please describe the types of activities you (and your family) enjoy .
*
Please describe your current living arrangements
*
Please Select
We own our home with substantial yardspace.
We own our home with a small yardspace.
We rent our home with substantial yardspace.
We rent our home with a small yardspace.
We live in a condo/apartment complex.
Do you currently have any other pets in your home?
*
Please Select
Yes
No
If so, please specify their species and ages
Does anyone in your household suffer from allergies due to animals?
*
Please Select
Yes
No
How many hours, in a typical day, will your puppy be left at home without your direct supervision?
*
Please Select
Less than 1 hr/day
1-2
2-3
3-4
4-5
5-7
>7 hrs/day
What would be the average duration of time that your puppy would be left at home without your direct supervision in a single instance?
*
Please Select
Less than 1 hr/day
1-2
2-3
3-4
4-5
5-7
>7 hrs/day
Do you plan to crate train this puppy?
*
Please Select
Yes
No
Unsure
Do you have a gender preference for this puppy?
*
Please Select
Male
Female
No Preference
Do you plan to have this puppy spayed or neutered?
*
Please Select
Yes
No
Unsure
Do you plan to use this puppy as breeding stock?
*
Please Select
Yes
No
Unsure
Do you plan to compete with your puppy in any of the following disciplines?
Conformation
Rally Obedience
Standard Competitive Obedience
Agility
Tracking
Field/Hunt
Other
If you selected the "Other" option above, please explain what other events you would like to participate in with your dog in
Do you plan to have this puppy enrolled in a Puppy Socialization Class?
*
Please Select
Yes
No
Unsure
Which brand and formula will this puppy be fed when it comes home?
Is there anything else you would like to tell us about yourself, your family, or what you are looking for in your new addition to your family?
Submit
Clear Form
To Contact Us: kohanagoldens@telus.net or Private Message our Page on Facebook at https://www.facebook.com/kohanagoldens
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