LOW COUNTRY GOLDEN RETRIEVER RESCUE RESOURCE
ADOPTION APPLICATION

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Minimum Adoption Donation is $225.00 unless otherwise stated. This helps us to recover some of the vet expenses typically incurred bringing the Golden back to optimal health.

PLEASE PRINT ALL INFORMATION

First Name: ________________________Last Name:________________________________

Co-Applicant: ________________________________________________________________

Street address: ______________________________________________________________

Mailing address (if different) _______________________________________________

City:_____________________ State: _________________ Zip: _____________________

Home Phone: _____________________ Work Phone(s): _____________________________

Email Address: _______________________________________________________________

A complete answer to the following questions will enable us to be more familiar with your request and requirements, and will help us find the Golden Retriever to match your needs and expectations.

Age desired: puppy to 1 yr___ 1-3 yrs___ 3-6 yrs___ 6-8 yrs___ 8+ yrs___

Would you consider a Special-Needs Golden such as one who requires medication for a permanent but controlled condition? YES___ or NO___

Will you accept a Golden-mix? YES___ or NO ___

Activity Level: High___ Medium___ Calm ___

Sex: Male___ Female___ Either___

Do you have any children who live with you? Yes__ No__
If yes, please give their ages:______________________________________________

Do they share your interest in adopting a Golden Retriever?___________________

Who is the dog primarily for:
Adult___ Child___ Elderly___ Physically Challenged ___

Who will care for, train and exercise the dog?________________________________

May we visit your home prior to application approval? YES ___ or NO ___

Please list all the pets you have owned in the past five years:

Species	Sex	Spayed/ Neutered?	What happened to the pet?

Please provide the full name, address, and phone number of your current veterinarian. If you have not used a vet in last 3 years please include the vet you plan to use:
Name ___________________________________________________ Phone _______________
City ____________________________________  State______ Zip ___________________

Do we have permission to contact your veterinarian? YES ___ or NO ___

How long have you lived at your current address?__________
Do you own ___ / rent ___?
If you rent:
   Landlord's Name_______________________________ Phone number _______________
   Do you have the permission of your landlord to have a dog? YES __ NO ___
   Up to what size? _____________

Will the dog be allowed in the house? YES__ NO ___

How long will the dog be left alone? _______________

Where will the dog stay when you are away from the house? ____________________

Where will the dog sleep at night ____________________________________________

Will your dog: (Check all that apply)
___ have the run of the house
___ be in blocked-off parts of the house
___ be tied outside
___ or live in the yard

Are you familiar with the use of a dog crate to train and/or confine the pet during your absence or at night? YES ___ or NO ___ -Are you willing to use a crate? YES__ or NO ___

Is your yard fenced? YES ___or NO ___ Type/Height of fence? __________________

If you do not have a fence, do you plan to install one? YES ___ or NO ___

Size of dog's yard area _________ Will the dog be walked daily? YES__ or NO___

Exercised in a fenced yard? YES__ or NO__ Allowed to run free? YES___ or NO___

LCGRR strongly recommends obedience training for all dogs under 2 yrs of age.
Are you willing to have your dog attend formal obedience training? YES___ or NO___

Have you ever owned a Golden Retriever? YES___ or NO___

Are you aware that Goldens are active and that they shed all year long? YES__ or NO___

How much do you think it costs for routine care for a dog on average a year? $_______________.

Have you sold, given away, or surrendered a pet to a shelter? YES ___or NO___ If Yes, please specify: _____________________________________________________

Please tell us why you want a Golden Retriever: ________________________________
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Please tell us a little of your lifestyle, your family including any special activities in which your dog would be included. (If you have any special requirements or requests for a dog, please let us know so that we can more carefully match a dog to your lifestyle) _____________________________________
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If you move what will you do with your dog? __________________________________

Have you applied to any other Golden Retriever Rescue groups? YES___ or NO ___

f Yes, please identify the group so that we may work with them to help find a golden that matches your needs _______________________________________________

Please tell us how you became aware of LCGRR and its programs:
Referral from whom? ________________ Web link from where? ____________________
Flyer __________ Web search _______________ Other:____________________________

I/We attest that the Terms and Conditions of Adoption have been read in full by me/us and I/we understand that it is part of the adoption process and will be enforced. I/we attest that the information provided on this application is true and accurate to the best of my/our knowledge. I/we attest that we have retained a copy of the Terms and Conditions of Adoption and also understand that completion and submission of this application does not guarantee adoption of a Golden Retriever. (If application is sent electronically, I attest that no changes have been made to the content of this document and I understand that my approval by signature is assumed)

Applicant's Name:____________________________________ Date:___________________

Applicants Signature: ________________________________________________________

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Return completed form to:
LCGRR,  P.O. Box 31256, Charleston SC 29417