Granite State Dog Recovery Adoption Application

Granite State Dog Recovery Adoption Application

7 Dartmouth Street Hooksett, NH 03106 ~ 1-855-639-5678 ~ www.granitestatedogrecovery.com gsdradopt@gmail.com
Name:

First NameLast Name
Home Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address:
Home Address:
No PO Box, please
Address (No PO Box, please)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
City & State & Zip Code
List all current species, breed, age of animal(s) living in your home:
Do you agree to let a GSDR volunteer conduct a home and wellness check prior to adoption?*

YesNo
Housing
Do you own or rent?

OwnRent
If applicable, may we contact your landlord?

yesno
If renting, provide full name and phone number of landlord:
If you have roommates, do your roommates agree to have a dog within the home?

YesNo
If yes, provide full names and phone numbers for each:
Do you have a fenced yard?

YesNo
Approximate size and height of fence:
Is the gate/or door of fence secure?

YesNo
Will the dog be left unattended inside the fence?

YesNo
Pet Ownership
Have you ever owned a dog in the past?

YesNo
Please list 3 prior breeds and years owned:
Have you ever adopted a pet before?

YesNo
List rescue(s) you adopted from:
Have you ever had to surrender or give up an animal?

YesNo
Do you work?

Full timePart timeRetiredWork from Home
How many hours will the dog be left alone?
Do you plan on using a dog trainer for obedience if necessary?

YesNo
Do you get annual check ups for your pets?

YesNo
Which veterinarian do you use or intend to use?
Please include location of veterinarian office
May we contact your vet?

YesNo
Do you plan on crate training the dog?

YesNo
Do you intend to leash walk the dog?

YesNo
Will you allow the dog off leash when not in a fenced area?

YesNo
Where will the dog reside?

IndoorOutdoor
Dog Characteristics
Which of the following dog behaviors/characteristics present a problem for you? (check all that apply)

Jumping on furniture/countersJumping a baby gateJumping on peopleSheddingChewing on shoes/furniturePlayful nippingBarking howlingGuardingDigging
Please explain how you would resolve the problem:
Why do you want to adopt a dog? (Check all that apply)

CompanionFamily petFor a childWatch dogGift or surpriseCompanion for another petOther
What characteristics are most important when considering which dog you'll adopt? (Check all that apply)

Good with large dogsGood with small dogsObedience trainedHousebrokenGood with catsFriendly/well socializedGood with kidsMaleFemaleShort hairNon-shed
Age Range:
Breed:
Size:
Color:
Would you consider providing a permanent home to: (Check all that apply)

Shy/timid dogHigh energy dogQuiet dogSenior dogHandicapped dogDog who needs trainingSpecial medical needsDog who needs housebreaking
Are you interested in a particular dog?

YesNo
Name of dog you are applying for: 1st Choice
Name of dog you are applying for: 2nd Choice
Provide 3 references who are familiar with your family/pets. (Please include full names, phone numbers, and relationship)*
Please notify references they may be contacted by a Granite State Dog Recovery Adoption Coordinator
By signing below, I certify that the information provided on this application is true and I recognize that any misrepresentation of facts will result in losing adoption privileges. I further understand that the adoption of this dog may be delayed until information can be verified. I authorize investigation of all statements in this application, understanding that veterinarians, landlords and personal reference may be contacted. I authorize the persons/entities listed above and/or their personnel to disclose to a representative of Granite State Dog Recovery information they possess regarding myself, my family and the treatment and service of my current or former pet(s). I understand that completing this form does not guarantee adoption of a dog. It is the responsibility of Granite State Dog Recovery to place this animal in an environment compatible with its needs and to ensure the adoption is in the best interest of both the animal and applicant. Granite State Dog Recovery reserves the right to deny any applicant. *
Print Full Name and Date:
Should be Empty:

Granite State Dog Recovery Adoption Application

Housing

Pet Ownership

Dog Characteristics