GHOG Dog Adoption Application

Thank you for taking the time to fill out our questionnaire. Our main goal is placing our rescued furkids in a compatible home with a family that will give them a LIFETIME commitment of love and proper care.

You can call on us at any time to help you in any way as our pets transition into your home. We are forever committed to each and every one from our rescue.

We reserve the right to refuse adoption to anyone for any reason. A representative of GHOG will conduct home visits prior to and/or following an adoption, and our group has the right to reclaim an animal following an adoption if, unsuitable home conditions, misrepresentation of self, evidence of neglect, abuse or other mistreatment of the animal are found on this visit.

NOTE: We do not ship or adopt our animals as gifts. We require a face-to-face meeting.

IN ORDER TO BE CONSIDERED AS AN ADOPTER TODAY, YOU MUST:
• Be 21 years of age or older.
• Be able and willing to spend the time and money necessary to provide training, medical treatment and proper care for a pet for the entire life of that animal.

PLEASE ANSWER ALL QUESTIONS COMPLETELY

Name of the dog(s) you are interested in:*

Your Name and Age:*

Spouse/Partner Name and Age*

Street Address:*

City, State, Zip*

E-mail(s):*

Primary Phone:*

Secondary Phone Number

Occupation(s) for adult(s) in home:*

Work hours*

Best way/time to contact you:*

2 Personal character references and phone numbers (not family member):*

How many adults are in your household?*

List children AND age(s) in your household/family *

Have your children been around animals before?*

YesNoNo children

Who will be the pet's primary caregiver?*

Do you live in a*

Do you own or rent?*

OwnRentLive with parents

If rent, provide name and phone number of landlord:*

Do you have a fully physically fenced yard?*

YesNo

Height and type of fence*

If no physical fence around yard, what form of restraint from straying do you plan to use?*

Does anyone in your home have allergies to dogs or have asthma?*

YesNo

Does any family member or friend/neighbor who visits have a fear of dogs? Please explain if yes.*

When you travel or vacation, what accommodations are made for your pets?*

Do you have a vacation planned this year and if so what are the dates?*

Why have you decided to adopt a puppy/dog?*

List any pets you own or have been in your family in the past five years, and their ages, spayed/neutered, etc*

Where are these animals now?*

Have your current pets been kept up to date on the following? Check all that apply if IS kept up to date:*

What kind of flea and/or heartworm meds for current or previous pets?*

Have you adopted from an animal welfare group before?*

YesNo

Have you ever fostered for a shelter or rescue?*

YesNo

Have you ever given up or "rehomed" a pet?*

YesNo

If yes, what were the circumstances?*

Have you had any puppies/dogs in your household within the past year with parvo, distemper, kennel cough, mange, or coccidia?*

YesNoNot sureNot that I am aware of

If yes, please explain how long ago, what treatment provided & final outcome*

If currently have dog (s), what is comfort level with other dogs? Check all that apply:*

Loves other dogsVery playfulSometimes shows aggressionIs typically timid and/or submissive around other dogsNo previous experience with other dogsVery limited experience with other dogsLots of experience with other dogs through doggy daycare, dog park, other dogs visiting, etc.Not sureNo other dogs in home yet

Please provide the name and phone number of your current and/or previous veterinarian or clinic:*

Are you aware of crate training, if needed?*

YesNo

How many hours each day will your new pet be home alone?*

Where will your new dog stay when nobody is home?*

Where will your new pet sleep at night?*

Do you allow pets on your furniture?*

Absolutely noYes alwaysPrefer notDepends on what they are comfortable with

How will you supervise the dog's outdoor activity?*

Please describe your exercise plan with your new pup/dog:*

Do you plan to take an obedience class with your dog?*

YesNoNot sureIf needed

What circumstances would lead you to give up your new dog and what would you do with him/her?*

What arrangements have been made to ensure your pets will be cared for if something would happen to where you were no longer able to care for them or in the event of your death? *

Any questions or other comments would like to add?

I understand that I assume full responsibility for the welfare of this pet from the date of adoption.

Signature

Type a question

Gracie's H.E.A.R.T. of Gold Dog/Puppy Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information