Your name:

Email address:

Street address:

City:

State:

Zip:

Home phone:

Work phone:

Fax:

Cell phone:

Occupation:

1. Why do you want a Golden Retriever?

2. Have you ever owned a Golden Retriever?

3. If so, do you still have that dog?

What happened to your last dog?

4. During the past five years have you:

Lost a pet (not through death)?

Had a pet poisoned?

Had an animal killed by a vehicle?

Had an animal die due to disease?

If yes, what disease?

5. Have you ever had a dog diagnosed positive with heart worms disease?

6. Have you ever sold, given away, or surrendered a pet to a shelter?

If yes, please elaborate

7. Have you ever bred a dog?

If yes, please elaborate:

8. For what purpose do you want this dog?

9. Do you have any other animals?

Please list type, age, and sex of other animals and for dogs and cats whether they have been spayed/neutered:

10. Are your dogs currently on heart worm preventative?

11. Do you have any children at home?

Please list the number of children and their ages:

12. What are the ages of other persons who visit you regularly?

13. Do you live in a house, apartment, or condo?

14. Do you rent or own?

15. If you rent, do you have the landlord's permission to keep a dog over 50 pounds?

16. Do you have a yard?

If so, is it fenced?

What type and height of fencing?

If no fence, do you plan to install one?

17. Will the dog be walked daily?

Exercised in a fenced yard?

Allow to run free?

18. Are you aware the Golden Retrievers are active and they shed all year long?

19. Do all of the family adults work?

Is someone home during the day?

20. What provisions will be made for your Golden Retriever if no one is home during the day?

21. Do you intent to keep this dog primarily indoors or outdoors?

Where will it sleep?

Please explain:

22. Will your dog have the run of the house, be in a blocked-off portion of the house, use a crate, be tied outside, or live in the yard? Please be specific:

23. If a behavioral problem arises, what corrective action will you take?

24. How often do you travel?

25. Do you have a sex preference? If so, male or female?

26. Do you have a color preference? If so please give first and second choices:

27. Would you accept a Golden mix?

28. Preferred activity level:

29. Would you consider:

The opposite sex of what you prefer?

An older dog?

Littermates or a bonded pair?

30. What size of Golden Retriever do you prefer?

31. Are other members of your household aware that you are considering adopting a pet?

32. Are you willing to travel to pick up your dog?

If so, how far?

33. Are you prepared to assume the financial responsibilities of caring for an animal, including inoculations, veterinary care, good quality food, licensing, etc?

Are you aware that the routine cost of maintaining a dog averages $600-700 per year?

34. We recommend a higher-grade food such a Eukanuba, IAMS, Pedigree, Nutro, etc. Are you willing to purchase this?

Are you aware that the cost of this grade of food is at least about $30 for a 40-lbs. bag?

35. Are you planning to move in the near future?

Whenever you do move, what will you do with your dog?

36. Is anyone in your household allergic to animals?

37. Are you aware that a Golden Retriever is a large active dog, capable of knocking down a child or frail person?

38. Are you familiar with the animal control regulations in your area?

39. is this Golden Retriever going to be a gift?

If so, for whom?

Does this person(s) know that she/he is/are getting the gift?

40. Do you understand that any rescue animal that you may adopt through Gulf South Golden Retriever Rescue will be spayed/neutered?

41. What circumstances, in your mind, justify getting rid of a dog?

42. Are you willing to allow a Rescue Representative member to visit your home by appointment?

43. How did you hear about Gulf South Golden Retriever Rescue?

44. Have you applied to any other Golden Retriever rescue or breed-placement groups?

If so, please identify the groups so that we may work with them to help find a Golden that matches your needs:

45. Do you accept that there will be a $250 to $300 fee for each adopted dog, and are you aware that said adoption fee does not cover transport of the dog to where you live (a cost of at least $300 is typically charged by the airlines for air cargo shipment of a Golden Retriever):

46. Please provide name, full address, and phone number of your most recent veterinarian(s). We MUST have an address and telephone number. If you have not used a vet in the last three years, please indicate the vet you plan to use and so indicate.

47. If you wish, please use the following comments area to tell us about yourself and your family, including any special activities in which your rescue dog would be included. If you have any special requirements for a dog, please let us know so we can more carefully match a dog to your lifestyle.