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

• Have you checked with your landlord for approval and paid any applicable deposits?
  Yes No
• Please provide your landlord's name, phone number and email.
  

Is anyone home during the day? (*) Yes No

Do you currently have children at home? (*) Yes No

• If yes, what are their ages?
  0-3 4-8 9+

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

• If yes, are they indoor or outdoor cats? Indoor Outdoor

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

• If yes, what type and when?
  

Do you have a fenced yard? (*) Yes No    If yes, please provide its height and a brief description.

• If some parts of the fence are lower than others, please specify the minimum height.
  Fence Height: --- 0 ft 2 ft 3 ft 4 ft 5 ft 6 ft 7 ft 8 ft
• Please describe the fence, e.g. wooden, picket, privacy, chain-link, vinyl rails backed by wire mesh, etc.
  

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

• If yes, when will your dog use it?
  

Will you use a chain, tie out, or cable runner to restrain your dog outside? (*)
Yes No

• If yes, please describe:
  

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

• If yes, where does the dog door lead into from the outside?
  

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

• If no, how will you train your new Golden?
  

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? (*)