Application 2019

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Golden Treasures requests what may seem to be a lot of information, but our goal is to find the right fit for you and for our dog. We ask about your home, interest, and lifestyle and then work to have that coincide with our dog's social, exercise and training needs. Our application process is designed to match the attributes and personality of our rescued Goldens to the home best-suited to each dog. If you are able to provide the special home that a rescued Golden deserves, we hope to be able to match you with the right dog.

About You and Your Family

Applicant's First Name

Applicant's Last Name

Applicant's Age

Co-applicant's First Name

Co-applicant's Last Name

Co-applicant's Age

Relationship to primary applicant

Applicant's Address

City

State

Zip Code

County

Primary Phone

Alternate Phone Number

Cell Phone

Employed or Retired Employed Retired

Names/ages of all other humans in the household:

Children - If you do not have children living in your home, will your adopted dog come in regular contact with children (e.g. grandchildren, etc?) Yes No No Children

If yes, please indicate ages and anticipated contact frequency.

Number of Adults in household

Number of Children under 21 in household

How should we contact you?

What is the best time to contact you?

Do you have any trips planned in the near future? If so, when?

Home Type Single Family Apartment Ranch Colonial Duplex

Are you the owner? If not, do you have written permission from your landlord to have a large dog? Owner Not owner/Have Permission Not Owner/No Permission

Do you have a completely fenced-in backyard? Yes No

Fence type and height

Do you agree to keep your dog contained in a fenced yard or on a leash when not in a fenced area? Yes No

Do you have a pool, pond, creek, or any other water on your property? Yes No

Will the dog regularly be taken to any other family residences, e.g. weekend or vacation home? Yes No

Are there pets in the home now? If so, tell us a little about them

Are your pets spayed/neutered? Yes No

Are all pets current on vaccines and are your dogs on heartworm prevention? Yes No

What brand of prevention and where do you obtain it?

Do you have any dog doors in your home leading to the outside? Yes No

If yes, will the dog have access to these when you are not home?

Where will the dog be kept or have access to when no one is home?

Is anyone in your household allergic to dogs?

Is anyone in the household afraid of dogs?

Is anyone in the household a previous GT adopter? If so, specify name

Does anyone in the house have a physical disability or serious health condition? Yes No

Caring for Your Dog

Who will be primarily responsible for the care of the adopted dog?

Is anyone regularly at home during the day?

Typically, how long will your dog be alone during the day?

Where will the dog be kept during the day?

Where will the dog sleep at night?

Where will the dog stay when you're on vacation?

Dog Ownership and Experience

Will this be your first dog? Yes No

Please list the names of other dogs you've had within the last 10 years, and the approximate time frame you've had them.

Will this be your first Golden Retriever or Labrador Retriever? Yes No

Have you ever sold, given away or surrendered a pet to another person or shelter? If so, please describe circumstances.

Have you ever had a pet die because of age, illness, accident or euthanasia? If yes, please describe the circumstances.

Have you ever used a crate to train a dog? Yes No

What type and brand of dog food do you currently use or have used in the past for your dogs? Do you measure the food or free-feed?

Have any of your current or past dogs ever had weight issues? Yes No N/A

If GT recommends using a higher quality food for your adopted dog, are you willing and able to make that change? Yes No

Do you plan to groom the dog yourself, or use a groomer or both? Yes No Both

If using a professional groomer, how often?

How will you exercise your dog?

How do you plan to train your dog to be a well-mannered member of the family?

Have you or a family member ever completed an obedience course with another dog? Yes No

Are you aware that routine costs of maintaining a dog average $800-$1,200 per year? Yes No

Breed Information and Preferences

Are you aware that Golden Retrievers are very active dogs (especially when young) and will require significant daily exercise and ongoing training? Yes No

Are you aware that Goldens shed year-round? Yes No

Are you aware that Goldens are large dogs and may jump and knock down young children or the elderly? Yes No

Do all members of the family want to adopt a GT dog? Yes No

Why do you want to adopt a rescued dog from GT?

What is your age preference? (check all that apply): 1-3 (adoption fee $400) 4-7 (adoption fee $300) 8 and older (adoption fee $200) No preference

Please specify which breed(s) you would consider (check all that apply): Golden Retriever Golden mix Non-Golden

What gender of dog do you prefer? Male Female Either

Would you consider adopting a bonded pair of dogs? Yes No

For applicants with no current dogs, would you consider a dog that does not get along well with other dogs? (We get many wonderful dogs that need to be "the only dog in the household.") Yes No Have another dog

Would you consider adopting a special needs dog? (E.g. one with physical or sensory impairment or one that requires medication to control a chronic but controlled condition?) Yes No

When will you actually be ready for a dog?

Veterinary Contact Information

Please contact your vet(s) within 1 business day and give them permission to release information to us.

Current vet's name, address and phone

Which dogs did this vet treat? Time frame?

Previous vet's name, address and phone

Which dogs did prevous vet treat? Time frame?

How did you hear about Golden Treasures?

Agreement & Signature

TERMS & CONDITIONS

The information I have provided in this Adoption Application Form is accurate and complete.

I understand and accept that Golden Treasures' adoption and matchmaking process involves mutual decision-making between the adopter, the adoption team and the foster home and is based on determining which family or individual can best meet the needs of each dog in the program. Golden Treasures' adoption team will take my preferences regarding age, activity level, etc. into consideration, but the completion of this application does not in any way guarantee that Golden Treasures will adopt a dog to me.

If I adopt a dog from Golden Treasures, it will reside in my home as a pet. I will provide it with adequate shelter, food, water, training, affection and medical care, including monthly heartworm preventatives.

I understand that I must consent to an interview and a home visit before approval to adopt a Golden Treasures dog is granted. Reference checks may also be required.

I understand and agree that Golden Treasures may refuse my application for any reason, at its sole discretion. I also understand that Golden Treasures may not disclose the reason for not approving my application, in order to maintain the privacy of both myself and the Golden Treasures volunteers.

I understand that upon completing an adoption, I must sign a mutually acceptable Animal Adoption Contract, which shall be provided by Golden Treasures.

Signature

Verification

Your application has been submitted.

Please remember to contact your vet and give permission to release info to us.

It may take a few days to review your information and get back to you.

Please be patient. We want to be sure to match the each dog to the right family.

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Golden Treasures Golden Retriever Rescue, Inc.
P.O. Box 434, Bath, Ohio 44210
Info@goldentreasuresrescue.org