Golden Retriever Freedom Rescue, Inc.

ADOPTION APPLICATION

First Name: _____________________ Last Name: __________________

Age: ______ Email Address: _________________________________________

Street Address: ____________________________________________________________

City: _______________________ State: ____ Zip: _________

Home Phone: ____________ Business Phone: ____________ Cell Phone: ____________

Best Contact Time: _______

Occupation: ____________ Work/Weekday Schedule: ____________

Co-Applicant First Name: _____________________ Last Name: __________________ Age: ______

Is anyone home during the day? ____________

Age and gender of other people in the household (full or part-time): ____________________________

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Do you currently have children? Yes____ No____

If yes, what are their ages? 0-3___ 4-8___ 9 and up___

Other regular visitors, children, animals to your home with which your new dog must get along:

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Who will be primarily responsible for this dog? ________________________

Do you live in a: ____ House ____ Townhouse ____ Apartment ____ Duplex ____ Condo

Do you: ____Own ____Rent

If you rent, have you checked with your landlord for approval and paid any applicable deposits? ____

Landlord Name: ___________________________Phone #: ________________

Have you ever had a Golden or owned any other dog before? ____ If yes, what type and when: ____

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List other pets you have, their ages, and if they are spayed or neutered: ____________________________

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If you have cats, are they indoor or outdoor cats? ___________
PLEASE NOTE: We cannot guarantee that all dogs in our program are compatible with cats; if the foster
home did not have cats we cannot be certain. GRFR will provide information to the adopter on how to
introduce dogs and cats. It is up to the adopter to follow safety procedures when introducing the new dog to
family cats in order to reduce the risk of injury to cats in the home.

Do you have a fenced yard? _____ Height and Type: ______________________
PLEASE NOTE: Adopting a dog under 3 years old may require a fence.

Do you have a dog kennel or doghouse in the backyard?______If yes, when will your dog use it? _____

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Will you use a chain, tie out or cable runner to restrain your dog outside? ______If yes, describe: ______ _____________________________________________________________________________________

Where will your dog be kept when you are away from home on a typical day (inside, outside, both, etc.)?

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How will you exercise your dog? __________________________________________________________

Are you familiar with crate training? ______ Will you crate train your new Golden? ______

Will you take your new Golden to Obedience Class? ______

PLEASE NOTE: A Golden Retriever's nature is that of very high energy and they require a great deal of
exercise, especially under the age of 3. If you do not have another dog, are not highly active, and do not
have a lot of time to spend training and caring for the dog, you will have an unhappy dog and you will not
be happy either. Please DO NOT check age 0-1 or 2-3 if you do not want a high energy dog. There is no
such thing as a mellow Golden puppy so don't believe it if anyone trying to sell you one says they
are mellow. Call any organization that uses Goldens to help the blind or disabled and ask them if you want
further confirmation!

What age range are you considering? __ 0-1 __ 2-3 __ 4-5 __ 6-9__ 10 + __ No Preference

Do you prefer __ Male __ Female __ Either Why? _________________________________________

Would you consider a Mix? ______________________________________________________________

How long are you willing to wait for a rescue dog?____________________________________________

When will you be ready for a new dog?_____________________________________________________

If you have a preference on age or gender, please explain, along with any other special requirements or
preferences so that we can match you with the most appropriate dog:

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Would you consider a special needs dog such as one who requires medication for a permanent
but controlled condition: ___________________________________________________________________

Give name, address, and phone number of your current vet along with current or previous pets’ names:

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Please provide us a second reference, either a neighbor, friend or relative.
Name: ____________________ Phone Number:__________________ Relationship: _________________

Please tell us about yourselves and why you want to adopt a Golden Retriever. We would like to hear about
what type of lifestyle a dog from our program would have if placed in your home and how your Golden would
fit into your daily activities. Please provide as much information as possible so we can ensure an appropriate
match with a rescue Golden. If you have never owned a Golden, why have you decided on one now?

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Submission of your application does not guarantee placement of a Golden Retriever. GRFR reserves the right
to reject any application for placement. Applicants must agree to a home visit prior to adoption approval.

The placement fee for a Golden Retriever is due at the time of placement. The placement fee ranges from $175.00
to $225.00 which covers the cost of medical treatment (spay/neuter, vaccinations, and heartworm check) given before
the Golden is placed. For puppies who are 10 months of age or younger, the placement fee is $225.00.
It is extremely rewarding to have people who are willing to make the last years the best years for our senior dogs.

Your application will not be submitted until after you click the submit button below!
An acknowledgement will be sent to your email address when we receive your application;
usually this will happen within a few minutes.

The following information should be read now, but is not signed until your new Golden has been placed with you.

This Golden Retriever must live inside your home as a loved family member. Goldens shed year round
and need to be brushed weekly, and they are large dogs that need to be exercised daily. Additionally, including
the cost of food, veterinary care, licensing, grooming, etc., you will need to spend between $500
and $1000 per year to care for your Golden. We place Goldens in "forever" homes. Are you willing to care for your
Golden for the rest of its life? Realizing that there are always exceptions, you must return your Golden to
GRFR if, for some unforeseen reason, you cannot keep the dog for its entire life.

I ACKNOWLEDGE THAT ALL THE INFORMATION CONTAINED IN THIS FORM IS TRUE AND
CORRECT TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT ANY MISREPRESENTATION
OF FACT MAY RESULT IN THE REMOVAL OF THE PLACED DOG FROM MY HOME BY GRFR.

Do you understand and accept all of these responsibilities?

Applicant Signature:___________________________________________ Date:____________________

Printed Name of Signature:______________________________________

Co-Applicant Signature: ________________________________________ Date:____________________

Printed Name of Signature:______________________________________

Please mail to:
Golden Retriever Freedom Rescue, Inc.
P. O. Box 9628
Denver, CO 80209-0628