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Adtoption - A Golden Opportunity

 Adoption Application

A successful adoption that matches the requirements and expectations for you, your family and the Golden, depends on selecting the right Golden for your household and a good understanding by all of the dog’s needs and care requirements. Please help us with this selection process by answering the following questions fully and completely.

 

Name of applicant
Name of co-applicant
Street address
City
State
Zip
Home phone
Work phone
Cell Phone
Email address(es)
Best time and method of contact
Applicant occupation and work schedule
Co-applicant occupation and work schedule
Are you aware that routine costs to maintain a dog averages $500 to $800 each year? Yes No
Are you aware that GRRH requests a $250 donation for adoption? Yes No
If we called tomorrow with the perfect Golden, would you be ready? Yes No
If not, please explain.
How did you learn about GRRH?
 
Information About Your Household  
Please list all members of your household, excluding pets. Indicate names & ages.
Please list all pets (dogs, cats, bird, etc.) of your household (names, ages, breeds, genders).
Are all of your pets spayed and/or neutered? Yes No
If no, please indicate the status for each pet.
Are all dogs in your household on regular, year-round heartworm preventative? Yes No
Other than children living in the household, will your Golden come into contact with any children under the age of 5 years (e.g., grandchildren, neighbors, etc.)? Yes No
If so, how often and what ages?
Do any elderly or physically challenged family members live with you or visit frequently? Yes No
Do you live in a... House? Yes No
Townhouse? Yes No
Apartment? Yes No
Condominium? Yes No
Trailer? Yes No
Do you... Own?  Yes No   
Rent?  Yes No
If you rent, do you have the landlord’s permission to own a dog over 50 pounds? Yes No
If you rent, may we contact your landlord? Yes No
If so, please provide name and contact information.
Do you have a fenced yard? Yes No
If yes, what type and height of fence?
Do you have a dog door? Yes No
 
Information About Your History With Pets  
Will this be your first dog? Yes No
Will this be your first Golden Retriever? Yes No
What other breed of dogs have you been the caregiver for?
If a pet has died that has resided in your household within the last 15 years, please explain when, at what age, and under what circumstances. Please include an explanation for each pet that has died.
Have any of your dogs had heartworms? Yes No
Have you ever bred a dog? Yes No
Have you ever sold a pet? Yes No
Have you ever given a pet away? Yes No
Have you ever surrendered a pet to a shelter?  Yes No
If yes, please explain the circumstances:
 
Information About The Care Of Your Golden  
Please answer all questions below. The answers will help us to determine which dog might be the best placement for you and your family
Do all members of the family want a Golden Retriever? Yes No
Why do you want a Golden Retriever?
Why do you think you would be a good caregiver for a Golden?
What age golden fits with your lifestyle and expectations?
Please explain.
Describe the characteristics you would like your Golden to have.
Are you aware that Golden Retrievers are very active? Yes No
Are you aware that Goldens shed year-round? Yes No
Are you aware that Goldens are large dogs and may jump-up on children and the elderly? Yes No
Is there anyone in your home who may be adversely affected by dogs (e.g., due to allergies)? Yes No
If so, please explain.
Who will care for, train and exercise the dog?
How will you provide exercise for your Golden?
Describe activities in which your Golden would be included (e.g. family outings, swimming, etc.)
Is anyone home during the day?  Yes No
If so, who and what age?
How long will the Golden normally be left alone each day?
Where will the Golden be kept during the day when no one is home?
When you transport/travel with your Golden, will your Golden ride in a car, truck, or both? Car Truck Both
If you answered either "Truck" or "Both" above, how will you restrain your Golden to keep him/her from jumping from or being tossed out of the vehicle?
What provisions have you made for your dog's care if you should get sick or hospitalized?
What will happen to the dog if you get married, have children, or divorced?
If you move what will you do with your dog?
What will you do with the dog when you are traveling for business or pleasure?
Will your dog...(check all that apply) Have the run of the house?                  Yes   No
Be in blocked-off parts of the house?    Yes   No
Be crated?                                         Yes   No
Be tied outside?                                  Yes   No
Live loose in a fenced yard ?                Yes   No
Live in a dog run?                                Yes   No
Roam loose?                                      Yes   No
Are you familiar with the use of a dog crate to train and/or confine the pet during your absence, for his safety, to aide in house breaking, to provide a safe haven, or at night? Yes No
Are you willing to use a crate? Yes No
Where will your Golden sleep at night?
Are you willing to... (check all that apply) Have your dog attend formal obedience class?                   Yes   No
Consult and expert for solutions to behavioral problems?     Yes   No  
Pay for one-on-one training if needed?                               Yes   No
Will you groom the Golden yourself or use a grooming service?
GRRH believes it is very important for dog owners to be aware of the laws governing them.  Are you familiar with your state, county and local dog laws? Yes No
Would you consider a special needs dog, such as one who requires medication for a permanent, but controlled, condition? Yes No
Do you prefer a... male    Yes No
female  Yes No
If you are interested in a specific Golden that you saw on www.grrh.org, please indicate the name(s).
   
Information About The Post-Application Process  
May we visit your home prior to application approval? Yes No
Please indicate the best day of the week and time during the day that you and your family would be available for a home visit.
May we contact your veterinarian? Yes No
If so, provide name and contact information of most recent vet(s). Addresses and phone numbers.
Our volunteers may take 2 weeks or more to complete the application process.  Are you willing to wait? Yes No
 
NOTICE:  Answers are expected to be complete and truthful, as they will enable us to be more familiar with your request and requirements, and will help us find the Golden Retriever which best matches your needs and expectations.  Failure to supply accurate information can result in revocation of the adoption at any time by GRRH.  By completing this form, the undersigned(s) expressly give permission to GRRH to verify the information contained in this Application, and further release GRRH from any and all liability associated with this Application or with the adoption of a dog through GRRH.
 
I/We attest that the Terms and Conditions of Adoption, as stated above, have been read in full by me/us and I/we understand that these terms constitute a part of the adoption agreement between me/us and GRRH and will be enforced.
 
I/we attest that the information provided on this application is true and accurate to the best of my/our knowledge. I/we attest that we have retained a copy of the Adoption Requirements and also understand that completion and submission of this application does not guarantee adoption of a Golden Retriever. (If application is sent electronically, I further attest that no changes have been made to the content of this document, understand that my approval by signature is assumed, and agree to transmit a signed original (or facsimile copy thereof) prior to any decision by GRRH on my adoption application.)
 
Applicant's Name
Date
Co-Applicant's Name
Date
Thank you for your interest in providing a loving, permanent home for a GRRH Golden Retriever.

Submission of an Adoption Application does not guarantee adoption of a dog through GRRH.

Please remember that finding the perfect rescued Golden for your family could take up to three months after you have been approved.

Thank you for opening your home and your heart to a rescued Golden!

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Last update on January 05, 2008
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