Sunshine Golden Retriever Rescue

Adoption Application Form

  01. Your First and Last Name  
  02. Your Age  
  03. Co-Applicant Name  
  04. Co-Applicant Age  
  05. Relationship to Applicant  
  06. Your Address  
  07. Your City  
  08. Your State  
  09. Your Zip  
  10. Your Email  
  11. Home Phone  
  12. Work Phone  
  13. Cell Phone  
  14. Your Employer  
  15. Your Occupation  
  16. Your Work Schedule  
  17. Co-Applicant Employer  
  18. Co-Applicant Occupation  
  19. Co-Applicant Work Schedule  
  20. How did you hear about us?  
  21. Time frame for adoption?  
  22. Where else have you applied?  
  23. Why do you want a Rescue Golden?  
  24. Dog Sex  
  25. If sex is required, please explain  
  26. Dog Age - you can select more then one   0 to 6 Months
6 to 12 Months
1 to 2 Years
2 to 3
3 to 6
Senior (7+)Years
No Preference
  27. Dog Size - you can select more then one   Small (45 to 55)
Medium (55 to 65)
Large (65 to 80)
X-Large(80 Up)
No Preference
  28. If size is required, please explain  
  29. Accept a Golden Mix  
  30. How important is it that a dog who is a mix “looks Golden”?  
  31. Would you accept a Golden Hearted dog  
  32. Would you be interested in adopting a bonded pair?  
  33. List the characteristics you want in a dog  
  34. Check behaviors that are not acceptable   Jumping
Chewing
Mouthing
Timid/Scared
High Energy
Alpha/Dominant
Counter Surfing
Requires Fencing
Excessive Barking
Not House Trained
Not Leash Trained
Separation Anxiety Issues
Needs Obedience training
Medication Dependent - Seizures, Thyrod
Physically Handicapped - 3 legs, 1 eye
  35. Have you ever owned a Golden Retriever before  
  36. Have you ever owned a rescue dog?  
  37. From where did you rescue your previous dog?  
  38. How many dogs have you owned as an adult?  
  38a. Pet #1 Name  
  38a. Pet #1 Type  
  38a Pet #1 Age  
  38a Pet #1 Sex  
  38a Pet #1 Where is this pet now?  
  38b. Pet #2 Name  
  38b. Pet #2 Type  
  38b. Pet #2 Age  
  38b. Pet #2 Sex  
  38b. Pet #2 Where is this pet now?  
  38c. Pet #3 Name  
  38c. Pet #3 Type  
  38c. Pet #3 Age  
  38c. Pet #3 Sex  
  38c. Pet #3 Where is this pet now?  
  38d. Pet #4 Name  
  38d. Pet #4 Type  
  38d. Pet #4 Age  
  38d. Pet #4 Sex  
  38d. Pet #4 Where is this pet now?  
  39. Have you ever   Had a pet who became lost?
Had a pet poisoned?
Had an animal killed by a vehicle?
Had an animal treated for a disease?
Had an animal die due to disease?
Sold, given away, or surrendered a pet to a shelter?
  40. If yes to any of the above, please explain in detail  
  41. Do you have other animals  
  42. For each animal that you own, please list "Type" breed for dogs  
  43. Please list "Age" for each  
  44. Please list "Gender" for each  
  45. Please list "Spayed or Neutered" for each  
  46. What food(s) does your current dog eat?  
  47. Are all pets up-to-date on vaccinations  
  48. If "no" please explain why not  
  49. List preventative treatments current pets receive  
  50. Describe your experience with training your previous dogs  
  51. Where do you plan to enroll your next dog for obedience training if it is required  
  52. Do you live in a  
  53. Do you rent or own  
  54. If you rent, do you have permission to keep a large dog  
  55. Please list your: Landlord's Name; Address; City, State, Zip, Phone Number  
  56. Do you have a yard?  
  57. What size is your yard?  
  58. Is it completely fenced?  
  59. What type and height of fencing?  
  60. If no fence or partial fencing, how will your dog be allowed to exercise, play, and relieve him/herself  
  61. How will your dog be exercised and how often do you plan to provide this exercise?  
  62. How often and under what circumstances will your dog be left unattended outside?  
  63. How often and under what circumstances will your dog be allowed to be off -leash?  
  64. Do you have a tie out or runner for your dog?  
  65. If yes, you MUST explain how and when it is used  
  66. Other than the applicant(s), how many adults in the household?  
  67. Ages of other household members(other than applicants) and relationship to applicant(s)  
  68. How will they be involved with care of the dog?  
  69. How many children in the house?  
  70. Ages of children in the house  
  71. Who will be responsible for the care of the dog?  
  72. Who will be responsible for the training?  
  73. How many hours a day on the average will the dog be left alone, without adults at home?  
  74. Where will the dog be kept when no one is at home?  
  75. What provisions will be made for your Golden during those times?  
  76. Will the dog be primarily kept  
  77. Where will your Golden sleep?  
  78. Will your dog  
  79. Please be specific and explain  
  80. What type of dog experience do you have?  
  81. How often do you travel  
  82. Who will care for your dog when you are away  
  83. Will this dog be a gift  
  84. If the dog is a gift, then for whom  
  85. Does the recipient know  
  86. Does your household want to get a rescue Golden  
  87. Are you willing to travel more than 2 hours to pick up your dog  
  88. Are you planning to move in the near future  
  89. Whenever you DO move, what will you do with your dog  
  90. Is anyone in your household allergic to animals  
  91. If they are allergic, please explain  
  92. Are you willing to allow a rescue volunteer to complete a home visit in order to approve adoption and at least one follow up after adoption  
  93. Do you accept that the total adoption fee for dogs is  
  94. Would you be willing to adopt a dog directly without meeting him or her first  
  95. Do you agree to contact your vet within 24 hours of this application to authorize release of information to SGRR  
  95a. Current Vet Name  
  95b. Current Vet Address  
  95c. Current Vet City, State, Zip  
  95d. Current Vet Phone  
  96a. Past Vet Used Name  
  96b. Past Vet Used Address  
  96c. Past Vet Used City, State, Zip  
  97. Tell us what dog(s) you're interested in  
  98. Do you agree to the following   Adoptions are completed with the signing of an adoption contract;
Under the terms of the contract, a SGRR dog may never be given
away or sold and MUST be returned to SGRR in the event
you are no longer able to care for the dog;
Your rescue Golden will be kept on heartworm prevention for the first 12 months you have him/her, and as recommended by your vet thereafter;
  99. Do you understand that we reserve the right to remove a dog at any time should we find the adopter is no longer caring for their Golden in a way we see fit.  
  100. We also require adopters to agree to follow up visits as needed.  
  101. By submitting this form I hereby authorize a SGRR representative to verify all information  
  102. All of the information I have given in this questionnaire is true and complete  
  103. By entering my signature here, means I have agreed to all the terms in this form  
  104. I understand that submission of an application DOES NOT guarantee a dog will be placed with me  
  105. Applicant's Signature  
  106. Date of Applicaton  
  107. Your Email