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document.write('<script type=\"text/javascript\" src=\"https://assets.bravenet.com/bn/js/emailfwd/bn_email_forms.min.js\"></script><link rel=\"stylesheet\" href=\"https://pub50.bravenet.com/emailfwd/v2/bnet-form.css.php?usernum=4277904062&formid=3658&formpadding=0\"><form method=\"post\" class=\"bnet-form\" enctype=\"multipart/form-data\" action=\"#bn-ajax-post:4277904062:50:3658\"><div class=\"bn-form-header\"><div class=\"bn-form-legend\"><div> Quincyridge Puppy Questionnaire        </div></div> <div class=\"bn-form-desc\"><p>Please be aware that there is generally a wait time for a puppy.  We do not have males but chose who we want to breed to to better our own line. We reserve puppies by deposit only. It is a revolving list according to when a deposit is received.  Thank you for taking the time to fill out this questionnaire. If you have a specific question for us there is a box below for that. Our dogs that are sold as a family companion on a Limited Registration with AKC. All dogs that are bred will have all required health certificates that can be verified with OFA (Canine Health Information Center)</p></div></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Enter Date </span> <span class=\"bn-input bn-date-input\"><input type=\"text\" name=\"Field-172503613910020\" validator=\"date\" placeholder=\"mm/dd/yyyy\" value=\"\"> <span class=\"material-icons bn-date-pick\">date_range</span></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Name <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"-172418641378496\" placeholder=\"\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">City/State you live in <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"-172418627418611\" placeholder=\"\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">email address <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"-172418633183760\" placeholder=\"\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Phone number <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"-172418636475728\" placeholder=\"\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Puppy Gender </span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-163068958208462[]\" value=\"Male \"> <span class=\"bn-inner-label\">Male </span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-163068958208462[]\" value=\"Female\"> <span class=\"bn-inner-label\">Female</span></label></span></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Puppies are sold with a Limited Registration (you cannot breed this dog). </span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-164199471437788[]\" value=\"I understand and agree\"> <span class=\"bn-inner-label\">I understand and agree</span></label></span></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">What time frame are you looking to get a puppy? </span> <span class=\"bn-input\"><textarea name=\"Field-172417564545784\" placeholder=\"\" validator=\"\"></textarea></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">What is most important to you in choosing a golden retriever puppy?  </span> <span class=\"bn-input\"><textarea name=\"Field-172625199679214\" placeholder=\"\" validator=\"\"></textarea></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">What physical characteristics do you prefer?  </span> <span class=\"bn-input\"><textarea name=\"Field-163069029885810\" placeholder=\"\" validator=\"\"></textarea></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Who will be the primary caregiver and what is the age of that party? </span> <span class=\"bn-input\"><textarea name=\"Field-172418497326710\" placeholder=\"\" validator=\"\"></textarea></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Describe your family and any other pets you may have? </span> <span class=\"bn-input\"><textarea name=\"Field-163110436566837\" placeholder=\"\" validator=\"\"></textarea></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">(Spay or neutering your puppy early) What is your plan? *Please note: Recent studies have shown that spaying or neutering early in your dog\'s life  can cause health issues.  </span> <span class=\"bn-input\"><textarea name=\"Field-174213026460090\" placeholder=\"\" validator=\"\"></textarea></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Describe how your dog will spend most of their day? (doggie day care , with family member, etc.)Other </span> <span class=\"bn-input\"><textarea name=\"Field-164199383301810\" placeholder=\"\" validator=\"\"></textarea></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Do you have the means to take care of your pet should an unforeseen accident or illness occur? Please note: There are low cost insurance plans available. </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-164199397997224\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><div class=\"bn-row\"><span class=\"bn-label\">Select what activities you are interested in (see arrow) </span> <span class=\"bn-input\"><span class=\"bn-select\"><select name=\"Field-172417854757345[]\"><option value=\"Companionship\" selected=\"selected\">Companionship</option><option value=\"Service dog\">Service dog</option><option value=\"Showing, Conformation, Rally, Obedience\">Showing, Conformation, Rally, Obedience</option><option value=\"Hunting or Field Activities\">Hunting or Field Activities</option><option value=\"Jogging\">Jogging</option></select></span></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">If you do not have an enclosed yard, what are your plans for daily exercise? </span> <span class=\"bn-input\"><textarea name=\"Field-169781381463755\" placeholder=\"\" validator=\"\"></textarea></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Will you be training your puppy yourself or enrolling in a puppy class? </span> <span class=\"bn-input\"><textarea name=\"Field-169780890240540\" placeholder=\"\" validator=\"\"></textarea></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Please tell us how you found us MHGRC,MFGRC,GRCA, or who referred you to our website? </span> <span class=\"bn-input\"><textarea name=\"Field-164199458838519\" placeholder=\"\" validator=\"\"></textarea></span></label></div>  <input type=\"hidden\" name=\"carboncopy\" value=\"\"> <input type=\"hidden\" name=\"thankyou\" value=\"\"> <input type=\"hidden\" name=\"thankyoutext\" value=\"Thank you for your form submission\"> <input type=\"hidden\" name=\"subject\" value=\"Contact form submission\"><div class=\"bn-form-submit\"><button type=\"submit\" class=\"formbtn\">Submit Form</button></div> <style type=\"text/css\">.bnet-form ::-webkit-input-placeholder {');
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