Form

Completion of this application is not a reservation or guarantee of a dog.SRGDRR, inc reserves the right to deny anyapplication for adoption for any reason.

SRGDRR’s mission is to re-home our dogs with loving, caring and responsible people.As such, all information will be verified. Incomplete applications will NOT be processed.

Name of Specific dog

Full Name

First Name Last Name

Spouses Name

E-mail

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

- Area Code Phone Number

Cell Number

Driver License/state/exp date

Driver License/State/Exp Date

Emergency Contact That does NOT live with you

Full Name

First Name Last Name

Phone Number

- Area Code Phone Number

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Have you ever owned a great dane before

Yes No

What would your preference be in your Great Dane

No Preference Some Preference

Gender

Male Female

Color

Age

Ears

Cropped Natural No Preference

How Many Pets do you Currently Own?

Please tell us type, breed, age,altered,and sex of all your current pets

Does the listed above get along with other dogs?

Yes No

Have you ever had to surrender an animal

Yes No

If yes, to above question, Please explain

Have you ever had to euthanize an animal? If so, Please Explain

Ever Bred a litter?

Yes No

Ever attend obedience Classes?

Yes No

What dog food do you Feed, or have you fed if you don't currently have any dogs?

Veterinarian Information (please list all that you have used in the past or currently use)

Full Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

- Area Code Phone Number

Full Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

- Area Code Phone Number

References - Please list 3 personal and non family members

Full Name

First Name Last Name

E-mail

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

- Area Code Phone Number

Full Name

First Name Last Name

E-mail

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

- Area Code Phone Number

Full Name

First Name Last Name

E-mail

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

- Area Code Phone Number

Housing Information

Size of your Yard

Fence? type? and gate latch

Is there shade in this area?

How many Hours will the dog be left outside?

How many hours a day will the dog be left alone?

What will you do with your animals if you go on vacation?

Are you Aware that kenneling is more expensive for a great dane?

Yes No

Please tell us All members of the household including ages and if they have allergies to pet dander

Do you rent or own? Please then tell us who you are renting from and include a copy of authorization stating you can have a Dane indoors

Authorization from landlord

May a SRGDRR rep visit your home to do a home check?

Yes No

Are you willing to give you dog at least one month to adjust to his/her new environment?

Yes No

Would you Consider a second dane in the future?

yes No

If a Great Dane is placed with me/us, I/we agree to cooperate with SRGDRR, inc in its attempt to provide a smooth transition for dogs and humans alike. I/we also agree to contact SRGDRR, inc about problems that might arise in the future. Should the dog need to be removed, or euthanized (prior to normal old age), I/we will contact SRGDRR, inc prior to taking any action to determine whether the dog might be a candidate for placement elsewhere. I/we certify that the information provided is true, correct, and complete to the best of my information and belief and that I have not willfully concealed any information in answering the above questions.

Srgdrr makes no warranty as to temperament or physical condition of the rescue. The rescue is being adopted as is. All rescues are advertised by information supplied from previous owners, shelters, and other forms. Srgdrr does not guarantee any DNA genetic makeup of any rescue an can not be held liable for rescue not being pure, or certain mix. There is no refund. DNA testing can be offered at the prepayment fee provided by adopter. It is not included in adopt fee donation.

Full Name

First Name Last Name

This is for your E-signature

- Month - Day Year

Signature *

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My Products

Application fee $ 20.00

Total $ 0.00

Adoption Application