GRRAND Adoption Application

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Submit your application online, or download the PDF and mail it.
Please note:  If you download the PDF, you must have Adobe Acrobat installed.

Privacy Statement
It is GRRAND's policy to maintain confidentiality over your information. We will not sell, rent or give your information to any other company or organization.

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Name

Address

City

State

Zip

Home Phone

Work Phone

Pager/Cell

Email

Your email address
Please enter your email address again

What is your occupation?

Place of employment:

To ensure that this placement is in the best interest of both you and the Golden Retriever, we ask that you answer the following questions:

Are you willing and able to spend the time and money necessary to proved training, medical treatment, and proper care for your dog for its entire life?
(Average life span of Goldens is 10 to 14 years)

Yes      No

Rescued Golden Retrievers may have been in neglectful and/or abusive situations, and therefore may experience difficulty making the transition to a new home. Are you willing to be patient while your golden adjusts to its new home?

Yes      No

What is your current living arrangement?

House	Apartment	Duplex
Mobile home	Condo
Other

Do you rent or own your home?

Rent      Own

Landlord contact information:

Landlord name

Landlord phone

Please list the following information for all the people living in your household.  Make sure to include yourself.

Example:  Spouse, children, etc.

Name: Age: Occupation: Interests: Work/school schedule:

Your pet will be kept:

Inside      Outside

Where will your golden be kept during the day?
Please be specific.

Where will your golden be kept at night?
Please be specific.

Where will your golden be when you are not home?
Please be specific.

What will you do with your golden when you go on vacation?  Please be specific.

Do you have a fenced yard?

Yes	No
Type:
Height:

If it is an Invisible Fence, please provide the name and phone number of the company that installed it.

Company 

Phone

Is this your first experience owning a dog?

Yes      No

What will be the main function of your adopted dog? 

Watchdog	Companion dog
Family pet	Companion for another animal
Other

Do you own any pets at the present time?

Yes      No

If yes, please provide the following information for each of your pets.

Name: Species/breed: Age: Vaccinations up to date - Y/N Spayed/neutered - Y/N

In the past 6 years, how many dogs and cats have you owned that you no longer have?

Dogs:    Cats:

Please describe these dogs and cats, and explain what happened to them.  Please be specific.

Please list your veterinarian's information.

Name

Phone

Address

My account is
under the name of:

Please list the names and phone numbers of three references.  At least two must not be family members.

Reference #1 Name   Phone   Best time to call

Reference #2 Name   Phone   Best time to call

Reference #3 Name   Phone   Best time to call

Please tell us why your home would be good for an adopted golden.

When and how did you hear about GRRAND?

Certification

Although I understand that every rescued Golden Retriever has been inspected and its history reviewed, I nevertheless appreciate and agree that Golden Retriever Rescue and Adoption of Needy Dogs, Inc. (hereafter referred to as GRRAND) has not made and does not make any warranty in regard to it and that GRRAND can only give me such information as they have received regarding the Golden. If at any time I desire to relinquish custody of the dog, I will contact GRRAND, who will attempt to assist in placing the dog. I understand that members of GRRAND will be following up on the status of any Golden they have assisted in placing and I agree to cooperate fully in allowing GRRAND representatives to visit my adopted pet in its new home at any reasonable time. I understand that should it be determined by GRRAND that my rescued dog is not being humanely cared for in its new home, I will upon request return the dog to them. I further understand and agree that any donation that I give to GRRAND's rescue and adoption program is a donation towards its work in caring for this and other rescued Goldens. By submitting this form, I hereby authorize a GRRAND representative to verify all information provided on this form and give our veterinarian permission to disclose all medical information requested by a GRRAND representative.