Name of Applicant/Dog's Primary Caregiver:

Address:

What area of town are you in, if you are in the Houston area?  Please list city, state, and zip code:

How did you hear about Golden Beginnings?

Daytime phone:             Evening phone: 

Best time to contact:            E-mail: 

Fax:          Cell/mobile phone: 

Spouse/Parent/Co-Applicant Name: 

Applicant's place of employment:

Driver's license number and state: 

Co-Applicant's place of employment:

Why do you want to adopt a Golden Retriever?

Companion           Guard dog             Child's Companion              Gift                                Personal Protection                             Other

Please explain in detail your idea of the Golden who would fit best into your home, and elaborate on the reasons you want a Golden Retriever, and tell us what your idea is of "the perfect pet" for your family:

Do you live in a:  House          Townhome/Condo           Apartment          Duplex                                                 Trailer         Other    

Do you:        Own        Rent

Do you have the landlors permission to have a dog over 50 lbs.?   yes         no

Landlord's name/address/phone (phone number MUST be provided): 

Do you have a fenced in yard?:  yes        no

Type of Fence: 

Height of Fence: 

Where will pet be kept during the day?  Be specific: 

Where will pet be kept at night? 

How many adults in the home?:          Ages?:  

How many children in the home?:      Ages?: 

List any Step-Children, grandchildren, cousins, friends children and their age(s), that visit week-ends or vacations: 

Are you aware that a dog of this size can easily knock down a child and/or the elderly?                      yes         no

Is there anyone at home who may be adversely affected by a dog?   (allergies, etc.):                      yes         no

Do all family members want this dog?  yes        no

Who will be responsible for the care of this pet?: 

Is there anyone home during the day?  yes        no

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

We require that all pets adopted from us be spayed or neutered.   Do you have any questions about this policy?  yes  no

If yes, please explain: 

Who will care for this pet while you are on vacation?: 

If you move, what will you do with this pet? 

Are you willing to take responsibility for this pet for 10 years or more of its life?                      yes         no

Are you aware of the costs involved to take care of this pet each year?  (grooming, licensing, food, vet care, treats, toys, obedience, training -- $600-$800 per year)                       yes         no

Have you ever participated in obedience training with a dog?   yes         no

Would you plan to take part in obedience training with the dog you adopt from us?                      yes         no

Please list all of the pets you've had in the past 5 years (type, sex, age, spayed/neutered, where is it now?): 

If you have had a pet die due to:  age, illness, euthanasia, accident -- please give details: 

Have any of your pets ever been treated for heartworms?  yes        no

Are all dogs presently living with you on regular heartworm prevention?  Please list type of medication, how often given, and if not on preventative, please explain why:

Are you familiar with the use of a dog crate to train and/or confine the dog in your absence?  yes         no

Will your dog be blocked off from certain portions of the house?   yes         no

Will your dog be tied outside?  yes        no

Will your dog live in the yard?  yes        no

If you do not have adequate fencing (a totally enclosed secure fenced yard), how will you exercise the dog?  Who will supervise these outdoor activities?  (This includes all the time the dog is outdoors). 

Will you groom the dog yourself or use a groomer?  self        groomer  both

Please give the names and phone numbers of two references: 

Please give the name and phone number of the veterinarian you plan to use: 

Have you used this veterinarian in the past?:  yes        no

In the event you are unable to care for this pet in the future, who will accept responsibility for its care for the balance of its life? 

Will rescue be notified?  yes        no

Rescued Golden Retriever Information:

Preferred sex:  male         female         no preference

Preferred age:  puppy     young adult  older adult     senior     no preference   

Would you consider a special needs dog (i.e. blind, deaf, hip dysplasia, etc.?):yes   no

Would you consider a senior dog?  yes        no

Do we have your permission to check your vet reference as well as your personal references?  yes     no

Do you have any special needs or wants?    

Please feel free to add any other information that you think might be helpful to us in evaluating your application: 

GBGRR is an all volunteer organization dependent on volunteers to help meet the many needs of abused and neglected Goldens

that enter our Rescue Program.  Most of our volunteer opportunities require only a couple of hours per month of your time.  Please

indicate if you are interested in becoming a volunteer and receiving additional information.

Thank you for taking the time to fill out our application, and for your interest in our program.   We will respond to your application as soon as possible; please remember that this organization is staffed totally by volunteers!

Golden Beginnings Golden Retriever Rescue
PO Box 19848
Houston, TX 77224-9848