HEARTLAND GOLDEN RETRIEVER RESCUE – ADOPTION APPLICATION

 

Thank you for your interest in adopting a Golden Retriever; please review our contract and Golden facts before completing this form. You will be required to sign a contract at the time of adoption

PLEASE NOTE: A submitted application does not guarantee adoption of a Golden from HGRR; nor that the dog an applicant would like to adopt from HGRR, is the one that is best suited to meet their needs; HGRR reserves the right to offer one they feel is better suited to match the application.

PLEASE PRINT YOUR ANSWERS

 

Name of Application (Dog’s Primary Caregiver):_________________________________________

Co-Applicant ______________________________________________

Mailing Address_____________________________________________    

Street Address (if different from mailing):_____________________________________________________

City: ______________________________ State: ________         Zip Code: ___________________ Home Phone: _____________________

Work Phone: _____________________Cell Phone_______________________ Best Time to Contact: ____________________________         

Email Address: ________________________________________________________

Do you have any children under the age of 18?     (Yes      No)     If yes, please give their ages _____________________________Do they live with you or visit you? ________________  Other family members/ co-inhabitants? _______________________________Do they share in your desire to adopt a Golden?   (Yes      No)      Does anyone in the household have allergies?  (Yes       No ) Are the allergies animal related?    (Yes     No)     How did you find us ( please circle one):   Past Adopter / Veterinarian/    Shelter orHumane Society/    Internet: Other (please explain ) _________________________________________________________     Have you owned a Golden in the past?   (Yes      No )         Have you applied to another group for a Golden?   (Yes     No)     If you have applied to another group, please provide the name and the date of application  ____________________________________   May our representative visit you at your home prior to adoption?    (Yes      No)  Would you consider a special needs dog (e.g., one who requires medication for a permanent but controlled condition such as seizures)  ( Yes     No )       A dog that is deaf or blind?     (Yes      No )  What age dog are you interested in adopting -      Any age?     (Yes      No)      Specific age (please give age)___________    Senior Dog (8 years or older)?   (Yes   No)   What activity level would you prefer?     High   Medium Low      Sexual Preference?   Male        Female            Doesn’t matter                  How long have you lived at your current address?________________________   Do you own or rent?    Own  Rent    (If you rent, please provide your landlord’s name, address, and phone number)___________________________________________________________________________________________Do you have your landlord’s permission to have a large dog at your residence?    (Yes    No)   Please identify all veterinarians used over the past five years (including name, address, and phone number):

 

Please list all the pets you have owned in the past three years and include:  species, sex of pet, whether spayed or neutered, if not altered, please explain:

 

Are these pet(s) still alive?  (Yes         No)      Have any of your pets ever been treated for heartworm?  (Yes     No  )    If yes, please explain the circumstances________________________________   Are all dogs currently living with you on heartworm preventative?  (Yes   No)     Please list the type of medication, how often given, and if not on heartworm preventative, please explain __________________________________________________________

Please list two references, one of whom must be a non-family member, including their names, addresses, and phone numbers:

 

 

We reserve the right to call your landlord (if one is renting).  May we have your permission to check your veterinarian and personal references?   (Yes     No)         If yes, please notify your veterinarian that we may call and that you give your permission for us to check on the past care of your animals.  Are you familiar with the use of a dog crate to train and/or confine the dog in your absence or at night?    (Yes      No )      Are you willing to use a crate (if needed)?    (Yes    No )     How long will your dog be left along during the day?  _______________   Where will the dog be kept during the day?__________________________________  at night?________________________________________       Is there anyone home during the day?     (Yes     No)    Is your yard fenced?        (Yes       No )         Type and height of fencing?_______________________________________ If you do not have a fence, will you install one?     (Yes       No)      What is the size of the dog’s yard area? ________________________________   Will the dog be walked daily?    (Yes     No)    

Exercised in a fenced yard?    (Yes     No )     Allowed to run free off your property?   (Yes     No )      Will your dog be in the house?    ( Yes     No )   Will your dog have the run of the house?    (Yes    No)         Be in blocked-off parts of the house?   (Yes     No)     Be tied outside?    (Yes     No)    Live in the yard?        (Yes      No)        Will your dog receive formal obedience training?         (Yes      No)          Have you ever trained a dog before?        (Yes        No)   Are you aware that Goldens shed all year long?      (Yes       No)     Will you groom your Golden or use a groomer?________________________________      Are you aware that routine costs of maintaining a dog can easily average $1000.00 per year?      (Yes       No)         In the event you are unable to care for this pet in the future, who will accept responsibility for its care for the balance of its life? ________________________________

Will you notify a golden rescue organization if this should occur? ___________________________________________________        Have you sold, given away, or surrendered a pet to a shelter or rescue in the past?      (Yes     No)    If yes, please give an explanation:

 

Please tell us why you want a Golden Retriever?

 

What type of activities will your dog and you enjoy together?____________________________________________________________    If you move, what will you do with the dog?_______________________________________________________________________      Are you willing to take responsibility of this dog for 10 years or more of its life?   (Yes       No)   Have you read our Adoption Procedure?   (Yes     No)  Have you read our contract?  (Yes   No)

 

Thank you for taking the time to fill out our application and for your interest in our program.  To ensure that prospective owners are serious about their adoption, a $25.00 adoption application fee is charged.  This fee is non-refundable but will be applied against the adoption fee if the application is approved.  Your application will not be processed until we receive this fee.  Submission of an application DOES NOT guarantee adoption of a dog from Heartland Golden Retriever Rescue.  We will respond to your application as soon as possible; please remember our organization is staffed totally by volunteers.

Please return this form together with a check made payable to HGRR to: Heartland GRR, 234 Morrell Road, #118, Knoxville, TN  37919-5876