application

Adoption Application

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Please print this form and mail to the address below. Or to submit an application online click Here

Name of Applicant: _____________________________________________________________

Applicant's email address: (Please print clearly) ______________________________________

Who will be dog's primary caregiver (if not applicant)? __________________________________

Relationship: Spouse: ______ Parent or Guardian: _____ Other: __________________________

Home Address: _________________________________________________________________

City: ____________________________________________ State _______ Zip: _____________

Daytime Phone: (____) ________________ Fax: (____) __________ H or W? May we call you at work? Y/N

Home Phone: (____) __________________ Best time to contact you: _______________________

Why do you want to adopt a Golden Retriever? _________________________________________

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How did you learn about GRRRR? __________________________________________________

If you found us on the internet, did you hear about us from Golden Retrievers in Cyberspace? _____

Petfinder? ___ Critter Connection? ___ General search? ___ Other? ____________________

Is there anyone in the home who may be adversely affected by care of dogs (allergies, etc.)? _______

Please describe: ________________________________________________________________

Names and ages of people who will be living with dog: ____________________________________

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Do ALL members of the family want this dog? __________________________________________

Are you aware that a Golden Retriever is a large dog and may jump up and knock down children or the elderly? _____

Do you live in a... House _____ Townhouse _____ Apartment _____ Duplex _____ Condominium _____

Do you: Own _____ Rent _____ Do you have the landlord's permission to have a dog over 50 lbs.? _____

Do you have a fenced yard? _____ Type and height of fence: __________________________________

Where will the dog be kept during the day? _____________________ At night? __________________

Is anyone home during the day? ____________ Who? _______________________________________

How long will the dog normally be left alone each day? _______________________________________

Will this be your first dog? _____ Your first Golden? _____ Other breeds you have owned: ____________

List any other pets you have and if they are spayed or neutered: Do they get along with other pets? ______

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Have any of your pets ever been treated for heartworms? ______________________________________

Are all dogs you currently own on heartworm preventative? ________ What kind? __________________

Have you ever bred a dog? _____________________________________________________________

Have you ever sold, given away or surrendered a pet to a shelter? ______ If so, please describe circumstances:

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If you have had a pet die because of age, illness, accident or euthanasia, please explain: ________________

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Will your dog have the run of the house, be in blocked-off portions of the house, use a crate, be tied outside or live in the yard? Please be specific: _________________________________________________________

Will your dog be allowed on the furniture or bed? _______________

Are you aware that Goldens are active and that they shed all year long? ______________________________

Will you groom the dog yourself? __________ Use a groomer? ____________________________________

Will the dog be walked daily? _________ Exercised in a fenced yard? _______ Be allowed to run free? ______

Do you plan to take an obedience course with your dog? ______ Have you ever taken one? ________

Are you aware that routine costs of maintaining a dog average $600 - $800 per year? _____________________

May we contact your veterinarian? _____ Please provide name, full address and phone number of most recent veterinarian(s): _____________________________________________________________________________________

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Rescued Goldens range in age: Are you interested in adopting: Any Age ____ Adult ____ Senior (9+ yrs) ____

Do you prefer: Male: _____ Female: _____ Does not matter: _____

Do you want to consider a special needs dog, such as one who requires medication for a permanent but controlled condition? ______________________________________________________________________________________

Describe the characteristics which you would like your dog to have: _________________________________

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Describe the characteristics which you do not want your dog to have: _________________________________

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Please tell us about yourself and your family, including any special activities in which your GRRRR dog would be included:

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If you are interested in any particular GRRRR foster dog, please list the dog(s) here: Listing a dog does not guarantee adoption of that dog.

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If you have any special requirements for a dog, please let us know so we can more carefully match a dog to your life-style.

I hereby authorize my veterinarian(s) to release confidential information about my pets and my pet care.

Applicant's Signature: _______________________________________ Date: ____________________

Co-Applicant's Signature: ____________________________________ Date: ____________________

Mail To:

GRRRR c/o Karen Fitzgerald
1117 W. Cedar St.
Olathe, KS 66061
EMail: KDeanie1@swbell.net

All calls will be returned collect (to control our expenses).

Questions about the adoption procedure? Please click here.

(If you obtain a dog elsewhere, please notify us so we can remove your application from our files).

Application does not guarantee adoption of a dog from GRRRR

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