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Golden Retriever Rescue of Central PA, Inc.
 
P. O. Box 397
Centre Hall, PA 16828
Telephone: 814-364-9744
E-mail: info@grrcp.org
Web site: www.grrcp.org

 

Golden Retriever Rescue of Central Pennsylvania

Adoption Application

Name of Applicant _________________________________Age ______

Street Address_______________________________________________

City ___________________________ State _____ Zip Code _________

Daytime Telephone _____________________________

Evening Telephone _____________________________

Best time to contact you _________________________________________

E-mail (optional)_______________________________________________

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

Age(s) _______________________________________________________

Who will be Golden's primary care giver (if not applicant)?

 

_____________________________________________________________

Relationship: Spouse ______ Parent or Guardian __________

Other (explain) ________________________________________________

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? ___________________

 

 

Page 2 – Adoption Application

Is the pet for (circle 1) an: Adult ___ Child ___Elderly person ___

Physically Challenged ____

How did you learn about Golden Retriever Rescue of Central Pennsylvania?

_____________________________________________________________

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 ____ Mobile Home ___ Condominium ____

Do you: Own _____ Rent ____ Do you have the landlord's permission to

have a dog over 50 pounds? ________

Do you have a fenced yard: Yes _____ No ____ Fence type and height

_____________________________________________________________

Where will Golden stay during the day? _____________________________

At night? _____________________________________________________

Is anyone home during the day? _________ Who? ____________________

Will your Golden have the run of the house, be in blocked-off portions of

the house, use a crate, be tied outside or live in the yard? Please be

specific:

_____________________________________________________________

Will your 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? ___________________

 

Page 3 – Adoption Application

 

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

If so, please describe circumstances?_______________________________

_____________________________________________________________

_____________________________________________________________

Are you aware that the routine costs of maintaining a dog average $600 to

$800 annually? ________________________________________________

Name and telephone number of veterinarian? _________________________

______________________________________________________________

May we contact him/her? _____________

á I hereby authorize my veterinarian to release confidential

information about my pets and my pet care.

Applicant's signature _______________________________ Date ________

Co-Applicant's signature ____________________________ Date________

If you have applied to another rescue for adoption, please list the name:

______________________________________________________________

Three personal references we may contact: Name and phone number of each

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Age range interested in adopting: Any age _________ Adult____________

Senior (9+ years) _________

Preference: Male _______ Female _________ No preference ___________

 

Page 4 – Adoption Application

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 those who will be living with and caring for the dog
  • Why you want to adopt a Golden Retriever. If you have any special requirements for a dog, please let us know so we can carefully match the dog to its “forever home.”
  • And describe in detail a typical week and weekend in the life of your dog. Please include any information about special activities in which your rescue dog would be included.

If, for any reason, the adopter should not be able to keep this dog, he/she is obligated to return the dog to GRRCP. _____________ Applicant’s initials

  • At the time of adoption, a non-refundable $325 adoption fee is required. Additionally, a $50 obedience deposit is also required at the time of adoption. This money will be refunded to the adopter once proof of a completed obedience course (taken within 3 months of adoption) is presented to GRRCP. Obedience class is a bonding opportunity for the new owner and Golden Retriever, offers them the chance to work through any adjustment problems and may someday save your dog’s life.
  • Adopters are not selected on a first come basis. GRRCP has the right to refuse any applicant. We strive to choose the most compatible environment for our Golden Retriever rescue dogs. Applicants must be over 21 years of age.

 

 

Applicant ______________________________________ Date__________

 

 

Co-Applicant ___________________________________ Date__________

 

 

 

 

 

 

 

 

Page 5 – Adoption Application

  • Please mail this application along with the non-refundable $25 application fee (made payable to Golden Retriever Rescue of Central Pennsylvania) to:

Golden Retriever Rescue of Central Pennsylvania

P. O. Box 397

Centre Hall, PA 16828

Applications without the $25 fee will not be processed until the fee is received.

  • Contact can be made by calling: (814) 364-9744 or by e-mail at info@grrcp.org
  • Thank you for your interest in giving a loving "forever home" to a needy Golden Retriever. Once the reference checks are complete, you will be contacted by a representative from GRRCP. The application process takes 2 to 3 weeks to complete before a home visit can be scheduled. Applying to adopt does not guarantee approval.

FOR RESCUE USE ONLY:

 

Reference calls made by: __________________________ Date ________

 

Home visit done by: ______________________________ Date _________

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