Adoption Application

Name of Applicant__________________________________Age___________________

Street Address____________________________________________________

City_______________________State________________Zip Code__________

Daytime phone_____________________Evening phone___________________

Best time to contact you_____________________________________________

Email (optional)___________________________________________________

Name(s) of Co-Applicant(s)__________________________________________

Age(s)___________________________________________________________

Who will be the Golden’s primary care giver (if not applicant)?______________

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Relationship: Spouse__________________Parent or Guardian_______________

Other(explain)_____________________________________________________

Keystone Golden Retriever Rescue rarely adopts to families with children under 8 years of age.
Will there be children living in the home with the Golden?__________________

If so, how many?_______Ages_______________________Gender___________

Is there anyone in the home who is allergic to dogs?_______________________

Is the pet for an: Adult________Child____________Elderly person___________

Physically challenged_______________?

Are you aware that a Golden Retriever is a large dog and may jump up and knock down someone?____________________________________________________

Do you live in a: House____________Townhouse___________Apartment_____

Duplex_________ Mobil home_____________

Do you: Own?____________Rent?____________Do you have the landlord’s permission to have a dog over 50 pounds?_______________________________

Landlord’s name and phone number____________________________________

Do you have a fenced yard: Yes_______________No____________ Fence type and height_______________________________________________________

Where will the Golden stay during the day?_____________________________

At night?________________________________________________________

Is someone home during the day?___________________Who?_____________

How many hours per day, (on average) will the dog spend alone?____________

Will the Golden have the run of the house, be blocked-off in portions of the house, use a crate, be tied outside or live in the yard? Please be specific: ______

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Will the dog be allowed on the furniture or the bed?_____________________

Is this your first dog?__________________first Golden?_________________

Are you aware that Goldens are active and shed year-around?______________

Do you have any other pets?________________Types and ages?___________

If you currently have pets, are all vaccinations current?___________________

If you have another dog, does that dog take Heartworm Preventative?________

If not, why not?________________________

Please list pets you have had in the past 10 years, along with this information:

Type/Name/Altered? Where are they now? If deceased, reason:

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

If so, please describe the circumstances___________________________________

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Will you plan to take an obedience course with your dog?__________________

KGRR is now requiring that adopters of certain dogs complete an obedience course. You must be signed up for a obedience course within 3 months of adoption. We will require an extra $50 deposit that will be returned, once proof of course completion is sent to the rescue. Dogs that need obedience will be determined by KGRR. If obedience course is not completed as advised by KGRR, the $50 deposit will NOT be refunded.

Are you aware of the costs involved in caring for a dog?__________________

Who is your current (or most recent) Veterinarian?___________________________

Veterinarian phone number: ______________________________________

Keystone Golden Retriever Rescue will contact your Veterinarian. Please contact

him/her and give permission for us to discuss your past pet history prior to Keystone’s

call.

Three personal references we may contact: Name and phone number of each, two of which are not relatives, one of which may be. For each phone number indicate home or work.

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Have you applied to any other rescues?___________________________________

If so, which ones?____________________________________________________

Age range you are interested in adopting: Any age___________ Adult________________Senior (9+ years)_________________

Preference: Male______Female__________No preference_______

At times we may have Golden mixes (Honorary Goldens) available for adoption.

Would you be willing to consider the adoption of a mix?___________________

If we call you tomorrow with a perfect dog for your family, would you be ready

to adopt?_____________________________

All of our Goldens are spayed or neutered before being adopted to their new homes.

The ONLY exception to this is the adoption of a puppy under the age of 6 months.

Upon the adoption of a puppy too young to alter, KGRR will require a deposit

of $50 that will be refunded upon receipt of the spay/neuter certificate from a

licensed Veterinarian. All adopters will sign a spay/neuter contract. If the dog

is not spayed or neutered by the appropriate age, KGRR reserves the right to

retake the dog into the rescue, and the deposit will not be refunded.

Would you consider a special needs dog, such as one that requires medication for a permanent but controllable medical condition?_____________________________

In addition to your application please send us a detailed letter about yourselves and why you want to adopt a Golden Retriever. Please include any information about special activities in which your rescue dog would be included. Also, if you have any special requirements for a dog, please let us know so we can carefully match the dog to its “Forever home.”

If for any reason the adopter should not be able to keep this dog, he /she is obligated to return the dog to Keystone Golden Retriever Rescue. The continuation of this program relies upon donations for medical and foster care for these homeless dogs. At the time of adoption, the non-refundable adoption fee is required. This money is used to help pay medical costs for homeless Goldens who enter our program.

Adopters are not selected on a first come, first serve basis. We strive to choose the most compatible environment for our Golden rescues. We reserve the right to refuse an adoption to any applicant. Adopters must be over 21 years of age.