Name: ( First, Middle Initial, Last )
Pets Name:
State and Drivers License Number:
Address: ( street, city, state, zip )
Home Phone:
Cell Phone:
Work Phone:
Employer Name and Address:
Spouse:
Spouses Employer Name and Address:
Number of adults in household: ( over age 18 )
Name of each adult in household:
Number of children in household:
Ages of children in household:
Who will be the primary caretaker of this pet?
Do all of the adults in the house consent to this adoption?
Does anyone in the house have pet allergies?
Other animals in household:
( Note: please list by name | m/f | age | species )
How long have you lived at your current address?
Do you plan on moving in the next 12 months?
Do you own or rent?
If you rent, does your landlord allow pets?
If you rent, please provide landlords name, address and phone number:
Do you live in a: house, apartment, mobile home, condo, townhouse, other ( if other please explain )
Where will this pet be kept?
(Examples - mostly inside, totally inside, mostly outside, totally outside, both inside and outside)
How many hours per day will the pet be home alone?
Yard:
Yard Fenced: ( if yes what height is the fence )
If no fence, how will you provide your dog's exercise and bathroom needs?
If you do not have a securely fenced yard, how will you ensure that your dog does not escape?
How will you ensure your dog stays on your property when you are not there?
Examples – in house, kennel, dog run, fenced yard, chain, rope, garage, patio, on lease in house, in crate in house, other ( if other please explain ).
Pool: ( if yes is it fenced? )
Pet door:
Vet information: Name, address and phone of your veterinarian or animal clinic.
(required)
Will you authorize a visit to your home before or after adopting a pet?
Are you willing to get obedience training if recommended?
Why do you want to adopt this pet?
ie companion for child, protection, gift companion for other pet, house pet, working dog, cat mouser. etc
Please feel free to provide any other information you feel is important for this adoption application.
Yes. By digital signing and submitting this form I agree that if for ANY reason I cannot keep the dog, the dog will be returned to Golden Bone Rescue and Rehab. That adopted pups that are too young to alter will belong to GBRR and will not be the property of the adopters until they provide certificate of spay/neuter.
Yes. By digital signing and submitting this form I agree that all puppies adopted through Golden Bone Rescue & Rehab must be neutered / spayed at the appropriate age. Certificate of spay / neuter must be sent to Golden Bone Rescue to confirm. Golden Bone Rescue & Rehab reserves the right to revoke any adoption if the puppy has not been spayed or neutered.
I agree to the following:
1) To contact Golden Bone Rescue & Rehab if I should become unable to keep the dog.
2) To a home visit conduction by a qualified GBRR volunteer.
3) The need for screening of potential adopters and the understanding that GBRR reserves the right to verify the information provided.
I certify that the information supplied in this interview is true and correct.
Date:
Email Address: