Internet 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.  If you hit "Enter" you will activate the "Submit" button.  Please enter "n.a." rather than leave a non-applicable line blank.
Name of Applicant:
Home Address:
City, State Zip:  
Phone Numbers: (Day)           (Eve)
E-mail Address:
Best time to contact you:

Who will be dog's primary caregiver?
Self (Applicant)
Spouse
Parent
Other


Why do you want a Golden Retriever?

Names and ages of people who will be living with dog:

Is there anyone in the home who may be adversely affected by care of dogs (allergies, etc.)? Please describe:

Do ALL members of the family want a Rescue dog?
Yes
No

Do you live in a...
House
Townhouse
Apartment
Duplex
Condominium
Other


Do you:
Own
Rent

Do you have the landlord's permission to have a dog over 50 lbs.?
Yes
No
Haven't asked
Don't need Landlord's permission

Do you have a fenced yard? |
No
Yes -
Type:

Where will the dog be kept:
During the day?
At night?

Is anyone home during the day?
No
Yes - Who?


Will this be your first dog?
Yes
No

Your first Golden?
Yes
No

List other breeds you have owned:


Are you aware that a Golden Retriever is a large dog and may jump up and knock down 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 dogs you currently own on heartworm preventative?
We have no other dogs.
No
Yes
What kind?

Have you ever bred a dog?
Yes
No

Have you ever sold, given away or surrendered a pet to a shelter?
No
Yes
If so, please describe circumstances:

Have you had a pet die because of age, illness, accident or euthanasia?
No
Yes
If so, please describe 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 use for grooming dogs.

Have you taken an obedience class in the past?
Yes
No

Do you plan to take an obedience course with this dog?
Yes
No

May we contact your veterinarian?
No
Yes

Please provide name, full address and phone number of most recent veterinarian(s):


I hereby authorize my veterinarian(s) to release confidential information about my pets and my pet care.

(Type your name here)

Rescued Goldens range in age. Are you interested in adopting:
Any Age
Adult
Senior (9+ years)

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 web site?
(If you obtain a dog elsewhere, please notify us so we can remove your application from our files).
Adoption Fee for all goldens is $250.00

Dallas Fort Worth Metro Golden Retriever Rescue ("DFWMGRR") is a not for 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:

read and understood


 




Dallas Fort Worth Metro Golden Retriever Rescue, Inc.
is a nonprofit 501(c)(3) organization, founded in 1986.
Info@RescueGoldens.org

Rescue and Adoption services for Golden Retrievers for the North Texas region.
PO Box 794374, Dallas, TX 75379
Hotline: 972-608-4488

Copyright © 1996 - 2002 Dallas Fort Worth Metro Golden Retriever Rescue, Inc.