Adoption Application

PLEASE READ OUR ADOPTION REQUIREMENTS CAREFULLY PRIOR TO SUBMITTING AN APPLICATION.

You must pay the non-refundable $25.00 application processing fee before you submit your completed Adoption Application. To pay the application processing fee, please click here to pay by credit card or PayPal (a new window will open).

Please retain your receipt and enter the last four (4) digits on the Adoption Application.

Please allow at least two weeks to process your application.

If your application is approved, it will be valid for one (1) year.

PLEASE TAKE YOUR TIME AND MAKE SURE THAT ALL QUESTIONS ARE ANSWERED OR YOUR APPLICATION WILL NOT SUBMIT.

Last 4 digits of PayPal Payment Receipt*

Contact Information

Name of Applicant*

Name of Co-Applicant

Email Address*

Home Phone

Cell Phone

Address

City

State

Zip Code

Applicant Occupation and Work Schedule

Co-Applicant Occupation and Work Schedule

Approximately how long will the Golden be left alone each day?

Is anyone home during the day? Yes No

Who and what is their age?

Where will the Golden be kept during the day when no one is home?

Preliminary Information

Are you aware the adoption fee is $600 for pups under one (1) year and $500 for dogs one (1) year to ten (10) years, and $300 for dogs ten (10) years or older? Yes No

Are you aware routine costs to maintain a dog average $2400 per year? Yes No

How did you learn about GRRH?

New Family Information

Please list all members of your household (excluding pets). Indicate names & ages.

Please list all pets (dogs, cats, birds, etc.) in your household. Include names, ages, breeds, & genders.

Are all of your pets spayed and/or neutered? Yes No

Please indicate the status for each pet.

Are all dogs in your household on a regular year-round heartworm preventative? Yes No

Will your Golden come into contact with any child under the age of 5 (e.g. grandchildren, neighbors, etc.)? Yes No

How often and what ages?

Do any elderly or physically challenged family members live with you or visit frequently? Yes No

Home Environment

What type of dwelling do you live in?

Do you rent or own? Rent Own

If you rent, may we contact your landlord? Yes No

Please provide your landlords name and contact information.

Do you have a fenced yard? Yes No

What is the type and height of the fence?

Do you have a dog door? Yes No

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?

Has a pet that has resided in your household died within the last 15 years? Yes No

Please include an explanation for each pet that has passed, including their age and under what circumstances.

Have any of your dogs had heartworm? 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

Please explain the circumstances...

Care of Your Golden

Do all members of your family want a Golden Retriever? Yes No

Why do you want a Golden?

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 is adversely affected by dogs (e.g. allergies)? Yes No

Please explain...

Who will care for, train, and exercise the dog?

How will you provide exercise for your foster Golden?

Describe activities in which your Golden would be included (e.g. family outings, swimming, etc.)

Where will the Golden travel in your vehicle?

What provisions have you made for your dog's care if you become sick or hospitalized?

What will happen to the dog if you get married, have children, or become 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?

The dog will... (check all that apply) Have the run of the house Be blocked-off in parts of the house Be crated inside Be tied outside Be left loose in fenced yard Live in a dog run

I am familiar with the use of a dog crate for... (check all that apply) training safety during my absence assisting in housebreaking providing a haven at night

Are you willing to crate at night? Yes No

Where will your Golden sleep at night?

I am willing to... (check all that apply) have my dog attend formal obedience classes consult an expert for solutions in behavioral problems pay for one-on-one training if needed

Will you groom the Golden yourself or use a grooming service?

Are you familiar with state, county, and local dog laws and are you willing to follow them? Yes No

Golden Preferences

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 or female Golden? Male Female No Preference

If you are interested in a specific Golden you've seen on our website, please enter their names.

Post-Application Process

May we visit your home prior to approval? Yes No

Please indicate the best day and time that you and your family would be available for a home visit.

Please provide the name, address and phone number of the veterinary clinic you currently use or have used.

Please list two references (other than your vet), their relationship to you and their contact information.

It may take at least two weeks to process your application. 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/we further attest that no changes have been made to the content of this document. I/we understand that approval by signature is assumed and agree to transmit a signed original (or facsimile copy thereof) prior to any decision by GRRH on my/our adoption application.)

Name of applicant

In lieu of Signature, please type your full name

Date of Signature

Name of co-applicant (if applicable)

(Co-Applicant) In lieu of Signature, please type your full name

Date of Co-Applicant Signature

Thank you for your Adoption Application!

Please allow us at least TWO WEEKS to review your application.

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