ADOPTION APPLICATION Thank you for taking the time to fill out this application. Please answer the questions in this application with your ultimate goal in mind: adopting a rescued Golden. Required answers are marked with an asterisk (*). If a question does not apply to you, please write N/A in the response area. Fill out this form completely and clearly in black ink only. Include area codes with all phone numbers, and include your E mail address, if at all possible. One of our representatives will be contacting you shortly after we receive your application. THE FOLLOWING CHECK LIST IS FOR YOUR USE TO ENSURE THAT YOUR APPLICATION IS COMPLETE AND WILL QUALIFY FOR CONSIDERATION: ADOPTION APPLICATION FEE Please include a check for the $50.00 non refundable application fee as your application will not be processed until we receive it. Return Adopters (i.e., persons who have adopted from Golden Bond Rescue previously) do not pay this fee. Please write at the top of this application: RETURN ADOPTER. FAMILIES WITH CHILDREN Golden Bond does not adopt dogs to households with children under 10 years old. Please review Kids and Dogs on our web site for specifics. FENCED YARD Please read "Fence Requirements" on our website for our policy regarding fencing. EXTREMELY IMPORTANT! Exceptions are rarely made. RENTED HOUSING Golden Bond Rescue will consider renters on a case by case basis. On occasion, Golden Bond Rescue will waive one or more of the requirements listed above. If you feel there are extenuating circumstances that qualify you for exemption, please contact Golden Bond Rescue before submitting your application to see if we concur. If you have general questions about rescue and adoption, please send email to goldenbondrescue@yahoo.com. Mail your completed Adoption Application to: Adoption Application Golden Bond Rescue of Oregon, Inc. 14111 S. Union Mills Rd. Mulino, OR 97042 TE: Make sure you have the correct postage when mailing this application. The Post Office will return envelopes requiring additional postage, holding up your application. We do not accept applications sent by email or FAX.
ABOUT YOU AND YOUR FAMILY Have you adopted a dog from Golden Bond Rescue before? * Your Name: * Age: * First Name Last Name Second Applicant's Name: Age: First Name Last Name Relationship: Spouse Partner Roomate Other If other, describe: If you think we may have trouble pronouncing your names, provide a phonetic guide here: Address: * Home Phone: * Street Address Street Address Line 2 Work Phone: City State / Province Postal / Zip Code Cell Phone: E mail address: Fax Number: Preferred phone number: Home Phone Work Phone Cell Phone Your occupation: * Second applicant's occupation:
Do you have children under the age of 18 who live with you? * Children Living With You Child 1 Child 2 Child 3 Child 4 Gender Age Name Relationship Are there any other residents in the house? * Relationship: Ages: Are ALL household members in complete agreement to adopting, caring for, and training a Golden Retriever? * Do any family members have an allergy to dogs? * If Yes, explain briefly how this situation is dealt with: Are there other people who visit your home at least once a week (neighborhood children, relatives, etc.)? * If, please describe who they are, their ages, and how often they visit: Are there other pets who visit your home at least once a week? If, please describe. TE: WE WILL ASK YOU ABOUT YOUR OWN PETS IN A LATER SECTION.
Visiting Pets Pet 1 Pet 2 Pet 3 Pet 4 Animal Type (dog, cat, etc.) Breed (dogs only) Gender (M or F) Age Spayed or Neutered? (S or N) Note: Part of agreeing to adopt a Golden will include an in home visit when all people and animals in the home are present. Are you agreeable to a home visit? * ABOUT YOUR HOME What type of home do you live in? * House Condo/Townhouse Apartment Mobile Home Other If Other, describe: Do you own or rent? * Own Rent Note: If you rent, please send a permission letter from your landlord. email: jdelaini@gmail.com fax: 503 200 2246 How long have you lived at your present address? (Years or Months) * What are the maximum number of steps in the home which the dog will be expected to negotiate on a regular basis?: *
What type of flooring do you have in areas where the dog will regularly be: carpet, tile, linoleum, wood, combo (please describe): * About Your Yard Does your property include an area which is completely enclosed by secure fencing (i.e., a dog can be released into without fear it will escape)? * Describe this area/yard in which your dog would have off leash access: Size of area/yard: * Approx. dimensions (feet by feet) Small Average Large Very Large Fencing material: If Other, describe: Wood Chain link Welded wire Other Height of fence (feet): * Enter 0 if no fence Do you lock your gates? Does this area/yard contain any of the following?: Gravel Grass Trees Bark dust Separate kennel run? Size of kennel run (feet by feet): If you live in a condo, townhouse, home, etc. where fencing is prohibited please let us know where the dog will be exercised in a secure area. Other Features Do you have a dog door? * Is the dog door large enough for a Golden?
If you checked to both, what two portions of your house and yard are connected by the dog door? Do you have a spa? * If, is it kept covered when not in use? Do you have a swimming pool or pond? * if, is it fenced? Describe type of fencing around pool/pond: Height of fencing (feet): Pool/pond's approx. dimensions (feet by feet): Approx. maximum depth (feet): Are there steps or a ramp that a dog could exit on? Are you aware that most Golden Retrievers enjoy swimming and if you have an unfenced pool or pond, the Golden will most likely swim in it? If you have a pond or pool, how do you plan to train the Golden to get out of the pool or pond? YOUR EXPERIENCE WITH PETS I consider myself: * an experienced Golden Retriever person (current or previous Golden Retriever owner as an adult) an experienced dog owner somewhat experienced with dogs (have been around dogs but not owned one) novice dog owner (have never owned a dog nor had significant experience with one) Note: Golden Bond Rescue does not consider having had a family dog as a child as providing significant experience. We are interested in knowing your experience with dogs when you have had primary responsibility for major decisions regarding them, i. e., you decided what kind and how much food to feed, when and whether to take it to a vet and then what kind of treatment to undertake, etc.
Please list your current or previous dog experience as an adult. Begin with your current or most recent dog(s) and work backwards. It is acceptable to estimate dates and ages. Dog Experience Dog's Name Gender (M or F) Breed Year Acquired Age When Acquired Spayed/Neutered? (S or N) Source: breeder, rescue group, etc. Year of Death Cause of Death Dog 1 Dog 2 Dog 3 Dog 4 Dog 5 If you have had more than five dogs as an adult, approximately how many more have you had? Were any of these a dog from a rescue organization? If, from what rescue organization(s)? Have any of your current dogs shown aggression towards another dog or people? * N/A If "", explain: Have you ever had to relinquish a dog? * If, what were the circumstances? Have you ever bred a dog? Are you familiar with the Golden Retriever breed? If you have never owned a Golden, how did you acquire your familiarity with the breed and why do you want one?
If you have a Golden presently, why do you want to adopt another? About Your Other Pets Non canine Animals you have currently: Pet 1 Pet 2 Pet 3 Pet 4 Types (cat, bird, livestock, etc.) Names Spayed/Neutered (S or N) Are all the pets, including dogs, present in your household up to date on their vaccinations? * N/A Do you have any immune compromised pets? Are there any special needs pets in your household? If Yes, please explain briefly their special needs and how you deal with them: Your Veterinarian May we contact your preferred veterinarian s office? * Note: Your preferred vet is the one who has seen your pets [including cats and/or other non canines] most recently and/or has the most complete records on them, including but not limited to vaccinations, annual exams, etc. He/she may not necessarily be your current vet. Golden Bond Rescue will call your veterinarian s office to ensure that you have provided at least adequate vet care to your pets. We care only about the quality of care provided we do not inquire about billing records or other personal information.
Veterinarian's office name: Veterinarian's phone number: Note: If the records for your pet(s) are under a different name (e.g., maiden name or name from a previous marriage) from that on this application, please give that name here. Similarly, if there are two different surnames given for the applicants on this application, please indicate the one under whose name the records will be found: Owner's name on vet records: If you have used another vet (e.g., cancer or orthopedic specialist) and wish to include their contact information, please give the office name and phone number here: THE PERFECT GOLDEN FOR YOU Please state briefly why you would like to add a Golden to your family: * What gender dog do you prefer to adopt? * Either Male Female What is your age preference? * Puppy Young (1 3) Adult (4 7) Senior (8+) Why? Note: Golden Bond generally finds that Goldens behave like puppies until about the age of three. Some dogs are lively and curious in the house they like to play with you and follow you around. Some dogs lie down most of the time. Do you think that an active dog will annoy you? What type of activity level are you comfortable with in a dog? * Sedate Active Very active
Do you plan to train your dog for a particular skill (Agility, Therapy, hunting, etc.)? What do you expect in a Golden Retriever companion? (e.g., protection, friendship, child's friend, appearance, hunting, obedience, agility, other): * Please rate the following canine traits according to how much they would displease you: Canine Traits Does Not Bother Slightly Displeasing Displeasing Very Displeasing Unacceptable Barking Chewing Digging Drooling Jumping Odor Shedding Are you aware that Golden Retrievers are 'people' dogs and will want to live inside with their human family? Will it displease you if the Golden gets up on your sofa or your bed? If, how would you train the dog not to get on the furniture? Do you plan to take your Golden to a dog park? Why, or why not? What type of personality are you comfortable with in a dog? Would you be willing to adopt a dog with health problems? * MAYBE
Note: By health problems, we mean diseases or conditions which are curable or controllable relatively inexpensively, such as allergies, arthritis and other joint issues, and low thyroid. Would you be willing to adopt more than one dog at a time (littermates or dogs that are inseparable)? * MAYBE Would you be willing to adopt a senior dog (10+ years old)? * MAYBE Would you be willing to adopt a special needs dog? * MAYBE Note: By special needs, we mean conditions such as special diets, assistance with getting into/out of a car, etc. Would you be willing to adopt a puppy or very young Golden (i.e., not fully grown)? * MAYBE Would you accept a mix that is part Golden? * MAYBE Have you seen a dog on the Golden Bond Rescue website which interests you? If you answered Yes, list the dog(s) by name and number and tell us what about the dog(s) interests you: Are there specific characteristics that would help us identify the best dog for you? CARING FOR YOUR GOLDEN Who will be the primary caretaker of the dog? * What is the longest your dog is likely to be left alone on a given day? *
How many times per week is this likely to occur, on average? * Where will the Golden sleep at night? * Where will the Golden be during the day when you are home? * Where will the Golden stay while you are gone during the day or evening (at work, on errands, at the movies, the gym, etc.)? * How often do you travel? * Note: We know that many people take their dogs with them when vacationing. The next question asks where your pet will be housed when and if a situation, e.g., an out of town wedding or funeral, arises in which you can t take your dog with you. When you travel, who will care for the Golden? * Kennel Friend's house Trainer Groomer Vet Home with visitor check House sitter Other If Other, describe: What type of vehicle(s) do you own? How will you secure the dog when transporting it in a vehicle (i.e., loose in the car, seatbelt, crate, etc)?: * How will you exercise the Golden Retriever? * Daily walks Fetching Jogging Hiking Swimming Run free in back yard Dog park Other If Other, describe: Will you keep a collar on your dog? * If, why not?
If, describe (buckle type, quick release type, chain type, etc.): ID tag? License tag? How much grooming are you planning to do? None Daily Weekly Monthly Are you aware that a Golden Retriever is a large breed and has higher maintenance costs (food, vet and grooming bills, equipment) than smaller breeds? Your Golden and Children If you plan to involve children under 16 years old in the care of your dog, how much adult supervision of dog and child will be provided? * Total Some Minimal None N/A With neighborhood children? * Total Some Minimal None N/A How much responsibility will your child or children be given in the care and management of the dog? (Skip the next section if you checked N/A above.) Children's Responsibilities Total Some Minimal None Housebreaking Socialization Feeding Household & Social Behavior Grooming Obedience Training
TRAINING YOUR GOLDEN Will you agree to take the dog to obedience classes if recommended by your Adoption Manager or the dog s foster family? * Have you ever completed an obedience class with a previously owned dog or current dog? If yes, what were the training techniques you learned? Do you understand that most of our rescue Goldens will come with minimal training and will need a large amount of patience? Are you agreeable to crate training? If, why not? Note: Some of the rescued Goldens have been backyard dogs or strays and are therefore not housetrained. Have you ever housetrained a dog before? Are you comfortable with having to housetrain a Golden?, but I would rather not Note: Some housetrained Goldens will have accidents in the house for a while after they come into an unfamiliar home. What steps will you take to help your Golden avoid house training accidents? Are you aware that the Adoption Fee for this dog(s) will be the least of your expenses during his/her lifetime?
Note: Expenses include good nutrition, annual vet exams and shots, and grooming. As with most pedigree breeds, Goldens may be prone to skin allergies, some degree of hip dysplasia and cancers that can be expensive to treat. Is there anything else that you would like to tell us about which we should take into consideration as part of your application?
GENERAL AGREEMENT I am at least 21 years of age. All of the information I have given is true and complete. I understand that Golden Bond Rescue of Oregon, Inc., has the right to refuse my application. I am applying to adopt and have enclosed the $50.00 non refundable application fee with this application. (Return adopters do not pay this fee.) Date * Applicant * Month Day Year First Name Last Name Applicant's Signature * Date Second Applicant Month Day Year First Name Last Name Second Applicant's Signature Thank you for your interest in Golden Bond Rescue of Oregon, Inc. We appreciate the time it took to fill out this application. When your application is received, you will be notified by either E mail or a phone call.