Adoption Application

PLEASE READ OUR ADOPTION REQUIREMENTS CAREFULLY PRIOR TO SUBMITTING AN APPLICATION.

You must pay the non-refundable $25.00 application processing fee before you submit your completed Adoption Application. To pay the application processing fee, please click here to pay by credit card or PayPal (a new window will open).

Please retain your receipt and enter the last four (4) digits on the Adoption Application.

Please allow at least two weeks to process your application.

If your application is approved, it will be valid for one (1) year.

PLEASE TAKE YOUR TIME AND MAKE SURE THAT ALL QUESTIONS ARE ANSWERED OR YOUR APPLICATION WILL NOT SUBMIT.

Last 4 digits of PayPal Payment Receipt *

Press enter or return on your keyboard/phone after you enter the digits.

Preliminary Information

Are you aware the adoption fee is $600 for pups under one (1) year and $500 for dogs one (1) year to ten (10) years, and $300 for dogs ten (10) years or older? *

Yes

Are you aware routine costs to maintain a dog average $3600 per year? *

Yes

I have read and agree to your Adoption Requirements which state “GRRH Will Not Adopt To Families with Children under the age of five (5) years of age." *

Yes

We are unable to allow you to continue to fill out the adoption form if you don't agree to our Adoption Requirements.

Contact Information

Name of Applicant *

Name of Co-Applicant

Email address *

Home Phone

Cell Phone

Street Address *

City *

State *

Zip Code *

Applicant Occupation and Work Schedule *

Co-Applicant Occupation and Work Schedule

Approximately how long will the Golden be left alone each day? *

Is anyone home during the day? *

Yes

Who and what is their age? *

Where will the Golden be kept during the day when no one is home? *

New Family Information

Please list all members of your household (excluding pets). Indicate names & ages. *

Please list all pets (dogs, cats, birds, etc.) in your household. Include names, ages, breeds, & genders. *

Are all of your pets spayed and/or neutered? *

Yes

N/A

Please indicate the status for each pet. *

Are all dogs in your household on a regular year-round heartworm preventative? *

Yes

N/A

Will your Golden come into contact with any child under the age of 5 (e.g. grandchildren, neighbors, etc.)? *

Yes

How often and what ages? *

Do any elderly or physically challenged family members live with you or visit frequently? *

Yes

Home Environment

What type of dwelling do you live in? *

Do you rent or own? *

Rent

Own

May we contact your landlord? *

Yes

Please provide your landlords name and contact information. *

Do you have a fenced yard? *

Yes

What is the type and height of the fence? *

Do you have a dog door? *

Yes

Your History with Pets

Will this be your first dog? *

Yes

Will this be your first Golden Retriever? *

Yes

What other breed of dogs have you been the caregiver for? *

Has a pet that has resided in your household died within the last 15 years? *

Yes

Please include an explanation for each pet that has passed, including their age and under what circumstances. *

Have any of your dogs had heartworm? *

Yes

Have you ever bred a dog? *

Yes

Have you ever sold a pet? *

Yes

Have you ever given a pet away? *

Yes

Have you ever surrendered a pet to a shelter? *

Yes

Please explain the circumstances... *

Care of Your Golden

Do all members of your family want a Golden Retriever? *

Yes

Why do you want a Golden? *

Why do you think you would be a good caregiver for a Golden? *

What age Golden fits with your lifestyle and expectations? Please explain. *

Describe the characteristics you would like your Golden to have. *

Are you aware that Golden Retrievers are very active? *

Yes

Are you aware that Goldens shed year-round? *

Yes

Are you aware that Goldens are large dogs and may jump up on children and the elderly? *

Yes

Is there anyone in your home who is adversely affected by dogs (e.g. allergies)? *

Yes

Please explain... *

Who will care for, train, and exercise the dog? *

How will you provide exercise for your foster Golden? *

Describe activities in which your Golden would be included (e.g. family outings, swimming, etc.) *

Where will the Golden travel in your vehicle? *

What provisions have you made for your dog's care if you become sick or hospitalized? *

What will happen to the dog if you get married, have children, or become divorced? *

If you move, what will you do with your dog? *

What will you do with the dog when you are traveling for business or pleasure? *

The dog will... (check all that apply) *

Have the run of the house

Be blocked-off in parts of the house

Be crated inside

Be tied outside

Be left loose in a fenced yard

Live in a dog run

I am familiar with the use of a dog crate for... (check all that apply) *

Training

Safety during my absence

Assisting in housebreaking

Providing a haven at night

Are you willing to crate at night? *

Yes

Where will your Golden sleep at night? *

I am willing to... (check all that apply) *

Have my dog attend formal obedience classes.

Consult an expert for solutions in behavioral problems.

Pay for one-on-one training if needed.

Will you groom the Golden yourself or use a grooming service? *

I'll groom the Golden myself.

I'll use a grooming service.

I'll groom the Golden myself and use a grooming service.

Are you familiar with state, county, and local dog laws and are you willing to follow them? *

Yes

Golden Preferences

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

Yes

Do you prefer a male or female Golden? *

Male

Female

No Preference

If you are interested in a specific Golden you've seen on our website, please enter their names.

Post Application Process

May we visit your home prior to approval? *

Yes

Please indicate the best day and time that you and your family would be available for a home visit. *

Please provide the name, address and phone number of the veterinary clinic you currently use or have used. *

Please list two references (other than your vet), their relationship to you and their contact information. *

It may take at least two weeks to process your application. Are you willing to wait? *

Yes

NOTICE: Answers are expected to be complete and truthful as they will enable us to be more familiar with your request and requirements and will help us find the Golden Retriever which best matches your needs and expectations. Failure to supply accurate information can result in revocation of the adoption at any time by GRRH. By completing this form the undersigned(s) expressly give permission to GRRH to verify the information contained in this Application and further release GRRH from any and all liability associated with this Application or with the adoption of a dog through GRRH.

Terms and Conditions of Adoption *

I/We attest that the Terms and Conditions of Adoption as stated above have been read in full by me/us and I/we understand that these terms constitute a part of the adoption agreement between me/us and GRRH and will be enforced.

I/we attest that the information provided on this application is true and accurate to the best of my/our knowledge. I/we attest that we have retained a copy of the Adoption Requirements and also understand that completion and submission of this application does not guarantee adoption of a Golden Retriever. (If application is sent electronically I/we further attest that no changes have been made to the content of this document. I/we understand that approval by signature is assumed and agree to transmit a signed original (or facsimile copy thereof) prior to any decision by GRRH on my/our adoption application).

Name of applicant *

Signature *

Date of Signature

Name of co-applicant *

Co-Applicant Signature *

Co-Applicant date of signature

Phone