TYPE OF APPLICATION

Adopt a Golden Retriever            

Be a temporary Foster Home for a Golden

APPLICANT INFORMATION

Name of Applicant:   

Applicant's email address: 

Home Street Address: 

City: 

State: 
                                                                                                       
Zip: 

Home Phone: 

Cell Phone: 

Fax: 

Best time to contact you:   

Who will be dog's primary caregiver (if not applicant)?  Self spouse son daughter parent other

How did you hear about Love A Golden Rescue?

WHY YOU WANT TO ADOPT or FOSTER

Why do you want to adopt/foster a Rescue Dog?

Why do you want to adopt/foster a Golden Retriever?

Is there anyone in the home who may be adversely affected by care of dogs (allergies, etc.)?    Yes    No

If answered yes above, please describe situation:

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

If children are in the home, what has been their past experience with dogs?

Do ALL members of the family want this dog?    yes   no

If someone is unsure about getting a dog, why?

Are you aware that a Golden Retriever is a large dog and may jump up and knock down children or the elderly?     yes    no

HOME INFORMATION

Please describe your dwelling:      Single home Duplex Townhouse Comdominium Apartment     Own    Rent

If your rent, do you have the landlord's permission to have a dog over 50 lbs.?     yes    no    not applicable

Do you live on a busy street?   Yes    No

Do you plan to move within the next year?   Yes   No

Please explain, if planning a move: 

Do you have a fenced yard?   Yes       No

Type of fence:       Height: 

Approximate size of fenced area: 

Is the fenced area secure for a dog?    Yes          No 

How do you plan to use this area? 

If you have an invisible fence, how do you plan to train your dog to use it?

Have you trained other dogs to use the invisible fence area?   Yes    No

Did those dogs ever escape the invisible fence?   Yes     No

Can other dogs come in your yard?   Yes      No

If you do not have any type of fence, have you kept a dog without a fence before?        Yes       No       Not applicable 

If you do not have any type of fence, how do you plan on letting the dog out for potty and to play?

Would you be willing to add a fence to your home?   Yes         No 

PAST DOG EXPERIENCE

Will this be your first dog?    Yes    No

Your first Golden?   Yes      No

Do you have other dogs now:   Yes      No

List the names, ages, breed and sex of your current dogs and whether they are spayed or neutered?

If you have owned other Goldens, tell us about them:

Other breeds you have owned in the past :

What characteristics of those breeds did you like?

OTHER PET INFORMATION

Do you have cats in your home?   Yes      No

If you do, please list the number of cats: 

 How do your cats relate with dogs: 

If you have cats, how would you introduce them to a new dog?

If you have cats, where do you feed them? 

If you have cats, where is the litter box? 

List any other pets you have and if they are spayed or neutered: Do they get along with other pets?

At what age and how did you acquire your current pets?

Do you plan to get any additional dogs or cats within the next year?
                 Yes         No 

Have any of your pets ever been diagnosed as having heartworms?
                 Yes          No

If yes, how was this condition resolved?

Are all dogs you currently own on heartworm preventative?  Yes     No

What brand of heartworm preventive? 

Have you ever bred a dog?              Yes       No

Have you ever sold a pet?                Yes      No

Have you ever given away a pet?   Yes   No

Have you ever surrendered a pet to a shelter?       Yes     No

If so, please describe circumstance:

If you have had a pet die because of age, illness, accident or euthanasia, please explain:

YOUR PLANS FOR A NEW DOG or FOSTER DOG

How would you exercise the dog?

Will the dog go outside “off leash” or unattended?   Yes    No

How often do you take walk or jog now?  

Where will the dog be kept during the day? 

At night?     

Is anyone home during the day?   Yes     No

Who?  

How long will the dog normally be left alone each day? 

Will your dog have the run of the house, be in blocked-off portions of the house, use a crate, be tied outside or live in the yard? Please be specific:

Are you aware that routine costs of maintaining a dog average $600 - $800 per year?      Yes        No

Will your dog be allowed on the furniture or bed?

Are you aware that Goldens are active and that they shed all year long?
     Yes    No

Will you groom the dog yourself?   Yes      No

Use a groomer?   Yes      No

How often do you plan to walk the dog?  

Will the dog be exercised in a fenced yard?    Yes      No

Will the dog be allowed to run free?     Yes    No

In what activities would your dog participate (e.g. jogging, camping, agility classes, therapy dog, etc.)

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

Have you ever taken one?   Yes       No

Where would you take obedience training?


REFERENCES AND CONTACTS

May we contact your veterinarian?   Yes     No   Don't have Vet 

I hereby authorize my veterinarian to release confidential information about my pets and my pet care   

Please provide the following information about your vet, if you have one:

Vet's name: 

Vet's address: 

Vet's phone number:

If you are a current or recent pet owner, during the application process, you may be asked to request that your veterinarian Fax a copy of your pet's vet records to Love A Golden Rescue. Our Fax number is 314-576-2775. Or we may ask to contact your veterinarian directly.

May representatives of Love A Golden Rescue visit you home prior to an adoption?   Yes     No

After adoption?     Yes    No
(Please note that a home visits are a requirement of adoption.)

If you adopt a dog from Love A Golden Rescue, may Love A Golden Rescue print your name as an adoptive home and tell others that you have adopted a dog from us?     Yes     No

If No, what are your concerns ? 

If you adopt a dog from Love A Golden Rescue, are you willing to provide Love A Golden Rescue with periodic updates about the dog? Yes   No

If No, what are your concerns?

If you adopt a dog from Love A Golden Rescue, are you willing to release the dog back to Love a Golden Rescue, if you no longer wish to care for the dog?     Yes      No

If no, what are your concerns?

Please provide 2 personal references that we may contact:

Name: 

Phone:

Address: 

City:  

State:

Zip:
 

Name:

Phone: 

Address:

City:

State:

Zip: 

ADOPTION or FOSTERING PREFERENCES

Age of dog you are interested in adopting or fostering (check all that apply):
(Note: we rarely have puppies)

Any age    Puppy (1 year or less)       Young adult (1-3 years)

Adult (4-8 years)           Senior (9+ years)

Do you prefer:     Male             Female             Either

Size (check all that apply):         less than 60 pounds
      60-75 pounds       75-90 pounds          over 90 pounds

Color preference:  

Activity level (check all that apply);

                     Low energy (couch potato):

                     Medium energy (some exercise but not intense):

                       High energy (lots of daily exercise)

Picture yourself coming home from work or an all-day outing. How would you like your dog to greet you?

How would you greet the dog?

What would you do if the dog had made a mess in the house?

How soon would you like to have an adopted/foster dog in your home? (Please note that the adoption process can take several weeks and its length depends on scheduling the home visit and on the availability of dogs currently have in foster homes.)

 

How far would you be willing to travel to pick up a dog for adoption or to foster?

Would you want to consider a special needs dog, such as one who requires medication for a permanent but controlled condition?   Yes     No

Describe the personality characteristics which you would like your dog to have: 

If you adopted a dog that chews, digs or has other bad habits, what would you do?

  

If your dog developed a serious health problem, what do you think your limitations would be?

Please tell us about yourself and your family, including any special activities in which your dog would be included:

If you are interested in any particular Love A Golden foster dog, please list the dog(s) here: Listing a dog does not guarantee adoption of that dog.

What about this dog appeals to you?

Rescue groups often work together.  Have you applied for a dog with another Rescue?     Yes    No
 
If yes, please give name of another Rescue: 


If you have any special requirements for a dog, please let us know so we can more carefully match a dog to your life-style:

Date of your adoption application: