2801 SE 4th St.
Blue Springs, MO 64014
Name of Applicant:
E-Mail Address:
If there is a specific dog you are applying for, please list name here:
Who will be dog's primary caregiver (if not applicant)?
Relationship: Self Spouse Parent Other
Home Address:
City:
State: Zip:
Daytime Phone:
Evening Phone:
Best time to contact you:
Why do you want a Golden Retriever?
How did you learn about this rescue group?
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:
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?
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?
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:
If you have had a pet die because of age, illness, accident or euthanasia, please explain:
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:
Are you familiar with the use of a dog crate for training purposes?
Will your dog be allowed on the furniture or bed?
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):
Rescued Goldens range in age. Are you interested in adopting: Any Age Adult Senior (9+ years)
Do you prefer: Male Female Doesn't Matter
Do you want to consider a special needs dog, such as one who requires medication for a permanent but controlled condition?
If you wish, please use the following comments area to tell us about yourself and your family, including any special activities in which your rescue dog would be included:
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.
Adoption Fees:
We ask a $190.00 adoption fee to cover our cost for vet checkup, shots, heartworm testing, spay/neuter, micro-chipping, etc..
(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 Midwest
Note: You will receive a confirmation email after submitting your application. If you do not hear from us in 24-48 hours after submittal, you could try submitting again or send an question email to Linda email: lklawrie@goldenrecovery.org