Adoption Application

Thank you for taking the time to fill out this application. Be sure to use the “tab key” to progress from one question to another, as the “enter” button will submit your application. Please enter N/A rather than leave a non-applicable line blank.

Name * First Last
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Home Phone * - (###) - ### ####
Cell Phone * - (###) - ### ####
Email Address *
Best Time to Contact You: * Morning Afternoon Evening
Who Will Be The Dog's Primary Caregiver? * Self (applicant) Spouse Parent Other
Why do you want a Golden Retriever? *
Names and ages of people living with the dog: *
Is there anyone in the home who may be adversely affected by the care of dogs (allergies, etc?) Please describe: *
Do all members of this family want a rescue dog? * Yes No
Do you live in a... * House Town House Apartment Duplex Condominium Other
Do You Own or Rent? * Own Rent
Do you have the landlord’s permission to have a dog over 50 pounds? * No Yes Haven't Asked Don't Need Permission
Do you have a fenced yard? * No Yes
If yes, what is the height of your fence?
Where will the dog be kept during the day? *
Where will the dog be kept during the evenings? *
Do you have a dog door? * No Yes Plan to install one
Is anyone home during the day? * Yes No
If yes, who?
Will this be your first dog? * Yes No
Will this be your first Golden Retriever * Yes No
Are you aware that a Golden Retriever is a large breed dog and without training may jump up and knock over children or the elderly? * Yes No
Are you aware that routine costs of maintaining a dog average $600-800 per year? Yes No
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? * Yes No
Are all of your dogs currently on heartworm prevention? * I/We have no dogs Yes No
Have you ever bred a dog? * Yes No
Have you ever sold, given away, or surrendered a dog to a shelter? * Yes No
If yes, please explain why...
Have you had a pet die because of age, illness, accident, or euthanasia? * Yes No
If so, explain the circumstances:
Will your dog: * Have the run of the house? Be in blocked off portions of the house? Use a crate? Be tied outside? Live in the Yard? Be walked daily? Exercised in a fenced yard? Be allowed to run free? Be allowed on the furniture?
Are you familiar with the use of a dog crate to train and/or confine the dog in your absence? * Yes No
Are you willing to crate train this dog? * Yes No
How will you groom the dog? * I don't think grooming will be necessary I will groom the dog myself I will use a service for grooming my dog
Have you taken an obedience class in the past? * Yes No
Do you plan to take an obedience class with this dog? * Yes No
May we contact your veterinarian? * Yes No I don't have a veterinarian
Please provide the name, full address, and phone number of most recent veterinarian:
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
I hereby authorize my veterinarian to release confidential information about my pets and my pet care. (Typing your name serves as your signature)
Rescued Golden Retrievers range in age. Are you interested in adopting: * 1-4 years 5-7 years Senior (8+ years) Any age
Do you prefer: * Male Female Either sex, it doesn't matter
Would you consider a special needs dog, such as one who requires medication for a permanent but controlled condition? * Yes No
If you have any special requirements for a dog, please let us know so we can more carefully match a dog to your lifestyle.
If you wish, please use the following comments area to tell us about yourself and your family, including any special activities in which your DFWMGRR dog would be included:
How did you find the DFWMGRR website? *
Dallas Ft. Worth Metro Golden Retriever Rescue (DFWMGRR) is a non-profit organization dedicated to the well being and placement of homeless Golden Retrievers into suitable homes. Be advised that:
1. Completing an application does not guarantee approval; and
2. Approval does not guarantee the placement of a dog.
In keeping with its goal of matching each Golden Retriever with the most favorable environment, DFWMGRR reserves the right to refuse to place any dog in any home for any reason. Before submitting your application, you must click the check box to show that you have read the notice above.
I have read and understand the terms and conditions above Yes No