First Name (*) Last Name (*)
Street (*) City (*) State AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY
Zip (*) Email Age (*) --- 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
Primary/Home Phone (*) Work Phone
Cell Phone Best Contact Time (*)
Occupation (*) Weekday Schedule (*)
First Name Last Name
Age --- 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
Do you live in a (*)House Townhouse Apartment Duplex Condo
Do you own or rent? (*)Own Rent
If you rent, please answer the following questions
Is anyone home during the day? (*) Yes No
Do you currently have children at home? (*) Yes No
Age and gender of other people in the household (full or part-time):
Please list other regular visitors, children, or animals with which your new dog must get along?
Do you currently have a dog(s)? (*) Yes No
Do you currently have a cat(s)? (*) Yes No
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.
List your current pets, their ages, and if they are spayed or neutered
Have you ever owned a Golden Retriever (or other dog) before? (*) Yes No
Do you have a fenced yard? (*) Yes No If yes, please provide its height and a brief description.
PLEASE NOTE: A fenced yard is generally required for Goldens under 8 years of age.
Do you have a dog house or a dog kennel in your backyard? (*) Yes No
Will you use a chain, tie out, or cable runner to restrain your dog outside? (*) Yes No
Where will you keep your new Golden when you are away from home for work, errands etc. on a typical day (inside, outside, both, both with dog-door, etc ) (*)?
Do you have a dog door? (*) YesNoN/A
Where will your new Golden sleep at night? (*)
How will you exercise your dog? (*)
Are you familiar with crate training? (*) Yes No
Will you crate train your new Golden? (*) Yes No
Will you take your new Golden to obedience class? (*) Yes No
Please provide the name, address, and phone number of your current vet along with current or previous pets' names. (*)
What age range are you considering? (*) 0-6mo 7-23mo 2-3yr 4-5yr 6-7yr 8-9yr 10+yr No Preference
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 0-6mo, 7-23mo, or 2-3yr if you do not want a high energy dog. There is no such thing as a mellow Golden puppy so don't believe it! Call any organization that uses Goldens to help the blind or disabled and ask them if you need confirmation!
Do you prefer: (*) Male Female Either
Why?
Would you consider a mix? We only take friendly mixes, like goldens/labs. (*) Yes No
Would you consider a special needs dog such as one who requires medication for a permanent but controlled condition? (*) Yes No
How long are you willing to wait for a rescue 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.
Who will be primarily responsible for this dog? (*)
What circumstances, in your opinion, could justify returning your new Golden to GRFR? (*)
Please provide us with a reference, either a neighbor, friend, or relative. (*) Name: Phone: (*) Relationship: (*)
When will you be ready for a new dog? (*)
Submission of your application does not guarantee placement of a Golden Retriever/Mixed Breed. 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/Mixed Breed is due at the time of placement. The placement fee ranges from $200.00-$550.00 which covers the cost of medical treatment (spay/neuter, rabies, Microchip, parvo/distemper vaccinations and heartworm check for out of state dogs) and transportation. For puppies who are 1 year old or younger, the placement fee is $550.00. For dogs, 1 year to 8 years old, the placement fee is $350.00. It is extremely rewarding to have people who are willing to make the last years the best years for our senior dogs. For senior dogs, age 8 years and older, the placement fee is $200.00.
Please enter the Security Code shown above (five characters, a mixture of alphabetic and numeric, no blanks, alphabetic characters are displayed in upper case but may be entered in either case, the displayed symbol for zero has a dot in the center).
This form is "sticky". If you mistype the Security Code, or fail to enter a required field, the form will be redisplayed with error messages at the top in a large bold font, but your input will be preserved. If your form is accepted, "Thank you <your name>" will be displayed in a large bold font at the top of the form
The following information should be read now, but is not signed until your new Golden/Mixed Breed has been placed with you.
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. **If for any reason you are unable to care for your ADOPTED GRFR DOG, they must be returned to GRFR.