About You and Your Family
Applicant's First Name
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Applicant's Last Name
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Applicant's Age
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Co-Applicant's First Name
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Co-Applicant's Last Name
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Co-Applicant's Age
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Relationship to primary applicant
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Applicant's Street Address
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City
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State
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Zip Code
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County
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Phone
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Alternate Phone
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Cell Phone
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Email
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Employment Status
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Answer Required Employed Unemployed Retired
Occupation
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Names/ages of all other humans in the household:
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Do you have children living at home?
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Answer Required Yes No
If no, will your adopted dog come in regular contact with children (e.g. grandchildren, etc?)
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Answer Required No Children Yes No
If yes, please indicate ages and anticipated contact frequency.
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Number of Adults in household
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Number of Children under 21 in household
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How should we contact you?
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What is the best time to contact you?
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Do you have any trips planned in the near future? If so, when?
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Home Type
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Answer Required Single Family Duplex Colonial Ranch Apartment
Are you the owner? If not, do you have written permission from your landlord to have a large dog?
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Answer Required Owner Not owner/Have Permission Not Owner/No Permission
Do you own a second home or property? If so what is the address?
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Do you have plans to move from your current home anytime soon?
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Answer Required Yes No
Do you have a completely fenced-in backyard?
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Answer Required Yes No
Fence Type and Height
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Do you agree to keep your dog contained in a fenced yard or on a leash when not in a fenced area?
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Answer Required Yes No
Do you have a pool, pond, creek, or any other water on your property?
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Answer Required Yes No
Will the dog regularly be taken to any other family residences, e.g. weekend or vacation home?
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Answer Required Yes No
Are there pets in the home now? If so, tell us a little about them, both DOGS & CATS
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Are your pets spayed/neutered?
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Answer Required Yes No No Other Pets
If not spayed/neutered, why not?
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Are all pets current on vaccines and are your dogs on heartworm prevention?
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Answer Required Yes No
What brand of prevention and where do you obtain it?
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Do you have any dog doors in your home leading to the outside?
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Answer Required Yes No
If yes, will the dog have access to these when you are not home?
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Where will the dog be kept or have access to when no one is home?
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Is anyone in your household allergic to dogs?
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Is anyone in the household afraid of dogs?
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Is anyone in the household a previous GT adopter? If so, specify name.
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Does anyone in the house have a physical disability or serious health condition?
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Answer Required Yes No
Caring For Your Dog
Who will be primarily responsible for the care of the adopted dog?
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Is anyone regularly at home during the day?
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Typically, how long will your dog be alone during the day?
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Where will the dog be kept during the day?
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Where will the dog sleep at night?
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Where will the dog stay when you're on vacation?
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Dog Ownership and Experience
Will this be your first dog?
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Answer Required 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.
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Will this be your first Golden Retriever or Labrador Retriever?
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Answer Required Yes No
Have you ever sold, given away or surrendered a pet to another person or shelter?
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Answer Required Yes No
Have you ever had a pet die because of age, illness, accident or euthanasia?
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Answer Required Yes No
If yes, please describe the circumstances.
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What type and brand of dog food do you currently use or have used in the past for your dogs?
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Do you measure the food or free-feed?
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Answer Required Measure Free-feed
Have any of your current or past dogs ever had weight issues?
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Answer Required Yes No Not Applicable
If GT recommends using a higher quality food for your adopted dog, are you willing and able to make that change?
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Answer Required Yes No
Do you plan to groom the dog yourself, or use a groomer or both?
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Answer Required Groom Yourself Professional Groomer Both
If using a professional groomer, how often?
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How will you exercise your dog?
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How do you plan to train your dog to be a well-mannered member of the family?
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Have you or a family member ever completed an obedience course with another dog?
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Answer Required Yes No
Are you aware that routine costs of maintaining a dog average $800-$1,200 per year?
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Answer Required 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?
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Answer Required Yes No
Are you aware that Goldens shed year-round?
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Answer Required Yes No
Are you aware that Goldens are large dogs and may jump and knock down young children or the elderly?
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Answer Required Yes No
Do all members of the family want to adopt a GT dog?
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Answer Required Yes No
Why do you want to adopt a rescued dog from GT?
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What is your age preference?
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Answer Required Puppy to 2 Years 2 up to 5 Years 5 up to 9 Years Over 9 Years ANY AGE
Comments about age preference (if any)
What is your breed preference
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Answer Required Golden Retriever Golden Mix Non-Golden
What gender of dog do you prefer?
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Answer Required Male Female Either
Would you consider adopting a bonded pair of dogs?
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Answer Required 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.")
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Answer Required 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?)
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Answer Required Yes No
When will you actually be ready for a dog?
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Current vet's name, address and phone
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Which dogs did this vet treat? Time frame?
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Previous vet's name, address and phone
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Which dogs did prevous vet treat? Time frame?
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How did you hear about Golden Treasures?
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Digital Signature
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Date
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Email
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If you are human, leave this field blank.