Adoption Application

Fields Marked with * are required

Contact Information

Name of Applicant (Dog’s Primary Caregiver)*

Co-Applicant (if applicable)

Mailing Address*

Address 2

Street Address (if different from mailing):



ZIP/Postcode *

Primary Phone *

Work Phone

Email *

Family Information

If you have any children under the age of 18, please give their ages:

If you have children under 8, please read our policy.
Do they live with you or visit you?
Live WithVisit
If there are there other occupants in the house, do they share in your desire to adopt a Golden?

Does anyone in the household have allergies?*
Are the allergies animal related?

Dog Preferences

How did you find out about us?*

Have you owned a Golden in the past?*
Have you applied to another group for a Golden?*
If you have applied to another group, please provide the name and the date of application

May our representative visit you at your home prior to adoption?*
Are you willing to consider a dog with special needs?*
A dog that is deaf or blind?
What age dog are you interested in adopting?*
0-6 Years7-8 Years9+ yearsAny Age
What activity level would you prefer?*
Would you consider adopting a Golden mix or x-breed?*
Sexual Preference*
MaleFemaleDoesn't Matter

Pet Care Questions

How long have you lived at your current address?*

Do you own or rent?*

(If you rent, please provide your landlord’s name, address, and phone number)

Do you have your landlord’s permission to have a large dog at your residence?
Please identify all veterinarians used over the past five years (including name, address, and phone number)*

Please list all the pets you have owned in the past three years and include: species, sex of pet, whether spayed or neutered, if not altered, please explain:

Are these pet(s) still alive?

Have any of your pets ever been treated for heartworm?
If yes, please explain the circumstances

Please list two references including their names, addresses, and phone numbers (Only one can be a relative. You cannot use a vet as a personal reference.)*

We reserve the right to call your landlord (if one is renting). May we have your permission to check your veterinarian and personal references?*
If yes, please notify your veterinarian that we may call and that you give your permission for us to check on the past care of your animals
Are you familiar with the use of a dog crate to train and/or confine the dog in your absence or at night?*
Are you willing to use a crate (if needed)?*
How long will your dog be left along during the day?*

Where will the dog be kept during the day?*

Where will the dog be kept during the night?*

Is there anyone home during the day?*
Is your yard fenced?*
If fenced, type and height of fencing?

What is the size of the dog’s yard area?

Will the dog be walked daily?*
Allowed to run free off your property?*
Will your dog be in the house?*
Will your dog have the run of the house?*
Be tied outside?*
Live in the yard?*
Will your dog receive formal obedience training?*
Have you ever trained a dog before?*
Are you aware that Goldens shed all year long?*
Are you aware that routine costs of maintaining a dog can easily average $1000.00 per year?*
Will you groom your Golden or use a groomer?*
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 you notify a golden rescue organization if this should occur?*
Have you sold, given away, or surrendered a pet to a shelter or rescue in the past?*
If yes, please give an explanation:

Please tell us why you want a Golden Retriever?*

What type of activities will your dog and you enjoy together?*

If you move, what will you do with the dog?*

Are you willing to take responsibility of this dog for 10 years or more of its life?*
Have you read our Adoption Procedure?*
Have you read our contract?

Important: If you get an error when submitting this form, please email us at, as there is a chance that the form was recorded in the database and we can pull it from there.