GRRCC Adoption Application

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Online Adoption Application

GRRCC is a non-profit organization.

(Application does not guarantee adoption of a dog from GRRCC.)

To be considered for adoption, the applicant must check and agree to all terms and conditions of the application and it must be completed in its entirety. Without this completed agreement, your application cannot and will not be considered for adoption approval.

I have read the eligibility requirements from the prior page:

I intend to apply for an exemption to one or more of the eligibility requirements as noted on the prior page:

If yes, please provide information on the eligibility requirement for which you intend to apply for an exemption.

Applicant:	First Name:		Last Name:		Age:
Co-Applicant:	First Name:		Last Name:		Age:

Relationship of the Co-Applicant:	Spouse
	Partner/Significant Other
	Parent or Guardian
	Other - Please Specify
Address:

City:	State: Zip Code:
Home Phone:
	May We Call You at Work?
	Work Phone Cell Phone:
	Best Time to Contact You:
	E-mail:

Other people who will be living with dog: (indicate name, age, gender, relationship to applicant and whether a part-time or full time resident of the household)

Why do you want to adopt a Golden Retriever?
How did you learn about GRRCC?

Are there any persons in the home with conditions or allergies that may
adversely affect the care of dogs?

If Yes, please describe:

Pet is primarily for:
Do you live in a:
Do you own or rent?

Do you have permission to have a dog over 50 lbs?
Do you have a fenced-in yard?
Approx. Dimensions:	Fence Type:	How high?
Is your lawn chemically treated? How often?

Is anyone home during the day?
Who?	How many hours/day
Who will be primarily responsible for the care of this animal?
Will this be your first dog?
Your first Golden?
List any other pets you own now: if dog(s), include breed(s)

Is your pet spayed or neutered:
On Heartworm Preventative?
Current on vaccinations?
Do they get along with other pets?
Have you ever bred a dog?
Do you plan to breed dogs?
Have you ever surrendered to a shelter, sold, or given away a pet?
If so, please describe the circumstances:
Have you had a pet die because of age, illness, accident or euthanasia?
If so, please explain:

Where will the pet be kept during the day/night?
Most of the time, will your dog:

Please provide more information about where your dog will spend his/her time. Be specific for both day and night:

Are you familiar with the use of a dog crate to train and/or confine the dog while you are not there?
Are you willing to crate train?
Where will the dog stay when you are not at home?
Will your dog be allowed on the furniture or bed?

Are you aware that Goldens are active and that they shed year-round?
Do ALL members of the family want this dog?
Are you aware that a Golden Retriever is a large dog and may jump and knock down children or the elderly?
How often would you groom your dog (or have it groomed)?
How will you exercise your dog (include how, where and frequency).
Do you plan to take an obedience course with your dog?
Have you ever taken one?
Are you aware that routine costs of maintaining a dog average $800 to $1000 per year?
May we contact your veterinarian?

Primary Veterinarian Information
Name:
Full Address:
Phone Number:

Please provide a little information about the Golden you are Interested in:

Age preference

From: To:

Would you consider a dog over the age of 8?

Do you prefer:

If there is currently a dog on our website that you are interested in, please tell us which one.

We encourage you to tell us about yourself and your family, including any special activities in which your GRRCC dog would be included.

If you have any special requirements or requests for a dog, please let us know so that we can more carefully match a dog to your lifestyle.

I/we attest that the Terms and Conditions of Adoption has been read in full by me/us and I/we understand that it is part of the adoption process and will be enforced.

I hereby authorize my veterinarian(s) to release confidential information about my pets and my pet care.

If you obtain a dog elsewhere, please notify us so we can remove your application from our files.

GRRCC is a volunteer staff organization and we there are many times when we need additional volunteers and services. Are you interested in volunteering with the organization?

Submitting a complete application does not guarantee adoption of a dog from GRRCC.

ADOPTION FEES: (payable upon adoption) Dogs up to 8 years old -- 250.00

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Golden Retriever Rescue Club of Charlotte · P.O. Box 471931 · Charlotte, NC 28247-1931