* Name

* Email

* Street Address

* City, State, Zip

* Home Phone

Work Phone

Cell Phone

Fax

* Occupation

* Why do you want a Golden Retriever?

* Have you ever owned a Golden Retriever?

If so, do you still have that dog?

If you have had dogs in the past, what happened to your last dog?

* Lost a pet (other than in death)?

* Had a pet poisoned?

* Had an animal killed by a vehicle?

* Had an animal die due to disease?

If yes, what disease?

* Have you ever had a dog diagnosed positive with heart worms disease?

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

If yes, please elaborate:

* Have you ever bred a dog?

If yes, please elaborate:

* For what purpose do you want this dog

* Do you have any other animals?

If yes, please list type, age, and sex of other animals and for dogs and cats, please state whether they have been spayed or neutered:

* Are your dogs currently on heartworm preventative?

* Do you have any children at home?

Please list number of children and ages:

* What are the ages of other people who visit your regularly?

* Do you live in a house, apartment, or condo?

* Do you rent or own?

If you rent, do you have your landlord's permission to keep a dog over 50 pounds?

* Do you have a yard?

If so, is it fenced?

What type and height of fencing?

If no fence, do you plan to install one?

* Will the dog be walked daily?

* Exercised in a fenced yard?

* Allowed to run free?

* Are you aware that Golden Retrievers are active and shed all year long

* Do all of the family's adults work?

* Is someone home during the day?

* What provisions will be made for your Golden Retriever if no one is home during the day?

* Do you intend to keep this dog primarily indoors or outdoors?

* Where will it sleep?

* Please explain:

* Will your dog have the run of the house, be in a blocked-off portion of the house, use a crate, be tied outside, or live in the yard? Please be specific:

* If a behavioral problem arises, what corrective action will you take?

* How often do you travel?

* What provisions will be made for your Golden Retriever if it becomes necessary for you to evacuate your home?

* If you have a gender preference, do you prefer a male or female Golden?

* If you have a color preference, please list first and second choices:

* Would you accept a Golden mix?

* Preferred activity level?

* The opposite sex of what you prefer?

* Littermates or a bonded pair?

* What age range do you prefer?

* What size Golden Retriever do you prefer?

* Are other members of your household aware that you are considering adopting a pet?

* Are you willing to pick up your dog?

If so, how far??

* Are you prepared to assume the financial responsibilities of caring for an animal, including inoculations, veterinary care, good quality dog food, licensing, etc.?

* We recommend a higher-grade food such as Eukanuba, IAMS, Pedigree, Nutro, etc. Are you willing to purchase this?

* Are you aware that the routine cost of maintaining a dog averages $600-$700 per year?

* Are you aware that the cost of this grade of food is at least about $40 for a 40-lbs. bag?

* Are you planning to move in the near future?

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

* Is anyone in your household allergic to animals?

* Are you aware that a Golden Retriever is a large active dog, capable of knocking down a child or frail person?

* Are you familiar with the animal control regulations in your area?

* Is this Golden Retriever going to be a gift?

If yes, for whom?

Does this person(s) know they are getting this gift?

* Do you understand that any rescue animal that you may adopt through Gulf South Golden Retriever Rescue will be spayed/neutered?

* What circumstances, in your mind, justify getting rid of a dog?

* Are you willing to allow a Rescue Representative member to visit your home by appointment?

* How did you hear about Gulf South Golden Retriever Rescue?

* Have you applied to any other Golden Retriever rescue or breed-placement groups?

If yes, please identify the group(s) so that we may work with them to help find a Golden that matches your needs:

* Do you accept that there will be a $250-$300 fee for each adopted dog, and are you aware that said adoption fee does not cover transport of the dog to where you live (a cost of at least $300 is typically charged by the airlines for air cargo shipment of a Golden Retriever)?

* Please provide name, address, & phone number of your most recent veterinarian(s). Include the pet's name & the owner's name as listed on the pets' records. If you haven't used a vet in the past two years, state it's a 'new' vet and provide the name, address & phone number:

If you wish, please use the following comments area to tell us about yourself and your family, including any special activities in which your rescue dog would be included. If you have any special requirements for a dog, please let us know so we can more carefully match a dog to your lifestyle.