Adoption Application

Contact information

Name *

Address *

City *

State *

Zip *

Home phone *

Cell phone

Email *

Employment

Occupation *

Employer *

Employer Phone

Consideration

The average Golden lifespan is 10-14 years

I will spend the time and money necessary to provide training, medical treatment, and proper care for my dog for its entire life.I understand this is a long-term commitment

Your adopted Golden may need time to adjust to its new home

Rescued Golden Retrievers may have been in neglectful and/or abusive situations, and therefore may experience difficulty making the transition to a new home.I understand patience is necessary as my Golden adjusts to its new home

Household

List all household members and corresponding ages. *

What are your current living arrangements? *

HouseApartmentDuplexMobile homeCondo

Do you rent or own? *

RentOwn

Does your lease allow pets? *

YesNo

Landlord name *

Landlord phone *

Will your dog have any contact with children under the age of 10?

Includes grandchildren, neighbors, etc.YesNo

Children in household *

Please list the ages of the children and frequency of contacts.

Typical weekly work schedule *Example: M-F 8:30 - 5:00

Typical weekly school schedule *"N/A" if not applicable

Interests What interests/hobbies do you enjoy?

Will your adopted Golden be kept inside or outside? *

InsideOutside

Dog location during the day *

Dog location during the night *

Dog location while you are away *

While you are on vacation *

Will your dog be left alone without human interaction on a periodic basis? *

YesNo

Description of time alone *

Please describe the frequency and time intervals the dog will be left alone.

Do you plan to exercise your dog on a regular basis? *

YesNo

Please describe the type of exercise and frequency *

Do you have a gender preference? *

MaleFemaleEither

Do you have an age preference? *

Puppy to three yearsFour to 7 years8+ yearsNo age preference

What activity level would you desire for your dog? *

LowLow to moderateModerateModerate to highHigh

Do you have a specific dog in mind from GRRAND's website? *

YesNo

Which dog(s)? *

Please list the name(s) of the dog(s) for which you have an interest.

Do you have an interest in adopting a special needs dog? *

A dog with a medical condition, or that is paired with another dog and cannot be separated.YesNo

Please describe the type of special needs dog(s) you would like to adopt *

Do you have a fenced yard? *

YesNo

What type of fence? *

Chain linkPrivacyUndergroundOther

Fence height *

Fence description *Please describe your type of fence

Invisible/Underground fence company *Please enter the name and phone number of the professional invisible fence company that installed your underground fence. NOTE: The fence company name and model/serial number can usually be found on the box where the fence is connected to electricity.

Company phone *

Current & Past Pets

Is this your first experience owning a dog? *

YesNo

What will be the main function of your adopted dog? *

CompanionWatch dogFamily petCompanion for another animal

Do you currently own any other pets? *

YesNo

Current pets *

For each of your current pets, please provide the following information:

Name - Species/breed - Age - Vaccinations up to date Y/N - Spayed/neutered Y/N

Dog history *In the past 6 years, how many dogs have you owned that you no longer have?

Cat history *In the past 6 years, how many cats have you owned that you no longer have?

Pet History Detail

Please describe these dogs and/or cats, and explain what hapened to them.

Veterinary Clinic Information Enter all requested veterinary clinic information for your current dog or cat. If you don't have a dog/cat currently, enter all of the information for your previous dog/cat. If you have never had a dog/cat, enter NA in the Name of Veterinary Clinic box. We cannot process your application without all of the information concerning your veterinary clinic.

Name of Veterinary Clinic *

Phone Number of Clinic

Vet Account Name The name under which your vet account is listed

References

Use the space below to list three references along with area code and phone numbers. Your application cannot be processed until we have made contact with your references. In order to expedite the processing of your application, please provide references who can be easily reached and who have been informed that they will be receiving a call from GRRAND volunteers on your behalf.

NOTE: You may NOT use your veterinarian or anyone else living in your residence as a reference. In addition, only one reference may be a relative.

Reference #1 name *

Reference #1 phone *

Relationship to You (friend, neighbor, relative, etc.) *

Is this a mobile phone that accepts texts?

YesNo

What is the best time of day to contact reference #1?

Reference #2 name *

Reference #2 phone *

Relationship to You (friend, neighbor, relative, etc.) *

Is this a mobile phone that accepts texts?

YesNo

What is the best time of day to contact reference #2?

Reference #3 name *

Reference #3 phone *

Relationship to You (friend, neighbor, relative, etc.) *

Is this a mobile phone that accepts texts?

YesNo

What is the best time of day to reach reference #3?

Comments

Please tells us why your home would be good for an adopted golden

How did you learn about GRRAND?

Is all required information complete?

Your application will not be sent if any required information is missing After you click "Submit My Application", you should see the message, "Your application has been sent". If this message does not appear, please check your application for missing information.

Age of Dog	Single Dog	Pairs	Pure Bred Goldens and Golden Doodles
3 and under	$375	$500	$500
4-6	$325	$400	$325
7-9	$250	$300	$250
10 and over	$100	Free	$100

GRRANDGOLDENS

Golden Retriever Rescue & Adoption of Needy Dogs

Adoption Application