Wufoo

Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
How long have you lived at this address? *
Email address *
Phone Number * ### - ### - ####
Are you over the age of 21? *
Yes No
Please list the other members of your household, including children. For adults 18+ please list full name. *
What is your current occupation and who is your current employer? *
What is the name of the dog you are interested in adopting? *
Why do you want to adopt this particular dog? *
The next step in adopting this animal if your application is approved is a home visit, which is just a casual visit to get to know you & discuss dog ownership. Are you comfortable with a GK representative visiting you at your home? *
Yes No
Will this be your first dog? *
Yes No
Where did you hear about us? (e.g. Adopt-a-Pet, Craigslist, Facebook, etc) *
Do you have any pets currently? If so, please tell us a little about them. *
Please list any pets you have had in the past but are no longer in your possession; give names and types and why you no longer have them (e.g. deceased, gave away, ran away, etc). If no previous pets, say n/a. *
Are your current pets spayed or neutered and have their vaccines up to date? *
Yes No N/A - do not have any pets currently
If you currently have dogs, which kind of heartworm preventative are they on? (If you do not have a dog, just answer "do not have dog" here.) *
If you currently have dogs or cats, what kind of flea preventative do you use? (If you do not have pets, just say "do not have pets.") *
Have you ever turned a cat or dog into a shelter or given a cat or dog away? If yes, please explain. *
Have you ever had a pet euthanized? If yes, please explain. *
Name of Veterinarian & Location
Veterinarian's Phone Number ### - ### - ####
If you do not have a veterinarian, are you willing to visit one within 14 days of adopting this dog in order to establish a relationship with one?
Do you rent or own your home? *
Rent Own
If you rent, please list your landlord's contact information here.
If you own, does this dog fall within the weight and breed restrictions as set forth by your Homeowners' Association, if any?
Yes No
How will your dog exercise? *
Will this dog live indoors or outdoors? *
How many hours per day will this dog be left home alone? *
During the time the dog is left home alone, where will s/he spend the time? *
Indoors, no restrictions Indoors, crated Indoors, confined to a safe room Outdoors, no restrictions Outdoors, in crate or kennel Other
If you would like to, please explain your answer above.
Under what circumstances would you give this dog away to a friend or family member? *
Expanding human family (e.g. having a baby) Breakup/Divorce Moving Change in economic circumstances (being laid off, etc.) Behavior problems in dog (e.g. barking, digging, potty accidents) Dog getting sick with an expensive illness Other (please explain below) There are no circumstances which would make me give this dog away.
Under what circumstances would you surrender this dog to the animal shelter? *
Expanding human family (e.g. having a baby) Breakup/Divorce Moving Change in economic circumstances (being laid off, etc.) Behavior problems in dog (e.g. barking, digging, potty accidents) Dog getting sick with an expensive illness Other (please explain below) There are no circumstances which would make me give this dog away.
Please make any comments you want to make about your answers to the two previous questions here.
What will you do if this dog decides s/he prefers chewing on your couch pillows rather than his/her toys? *
Do you agree to donate the appropriate adoption fee for this pet? The dog adoption fee is $125-200 (fee for each specific dog is indicated on its adoption listing). While this donation does not cover the full medical expenses paid by the rescue, this is the amount agreed as a fair donation. *
Agree Do not agree
You understand that you are applying to adopt a dog whose medical history is unknown before it entered the rescue. We address all known medical issues when the dog comes into the rescue, but we cannot predict any future medical problems. You agree that, as the dog's legal owner, all future veterinary costs are your sole responsibility from the date of adoption forward. *
Agree Do not agree
The average expense for a dog is $200-2000 in food and veterinary costs pear year. Do you agree to make such a financial commitment to this dog? *
Agree Do not agree
Do you agree to seek prompt and quality veterinary for this dog as soon as the need arises? *
Agree Do not agree
Over-the-counter flea and tick preventatives (Hartz, Adams, etc.) can be extremely dangerous to cats and dogs. Reactions can cause problems such as skin inflammation, seizures, and death. Do you agree to only use veterinarian-approved products such as Revolution, Frontline, Advantage, Capstar, and Program? *
Agree Do not agree
The average dog's lifespan is 10-15 years. Do you agree that you are comfortable making a commitment to this dog to be its guardian and caretaker for the rest of its life? *
Agree Do not agree
Please provide two personal references here (name and phone number, please). *
What provisions will you make for this dog should you become unable to care for him or her? List potential reasons that would render you unable to care for this dog. *
Any additional questions or comments here, please. *
[ELECTRONIC SIGNATURE] Please type your name here to certify that all of the information contained within this application is true to the best of your knowledge. *
Do Not Fill This Out