* = Required - If a required action is not applicable, type N/A.

Applicant Intention:
Adoption Foster FWITA Renewal

Current GRRoW Volunteer?
Yes No

*Today's Date:

*Primary Applicant Full Name:

*Primary Applicant DOB:

*Email:

*Home Phone:

Work Phone:

Cell Phone:

Preferred Method to be reached:
Email Phone

Secondary Applicant Full Name:

Secondary Applicant DOB:

Secondary Email:

Secondary Work Phone:

Secondary Cell Phone:

*Address:

*City:

County:

*State:

*Zip:

*Name and age of ALL other household members:

Current Housing:
House Apartment Condo Other

Do you:
Own Rent
(If renting, you must provide copy of written permission for dog ownership at home visit.)

Have you owned a Golden Retriever?
Yes No

Have you adopted from GRRoW?
Yes No
If yes, which dog and when?

*What are your plans for a Golden?

*Where will your Golden sleep at night?

*Where will your Golden be housed during the day when you are at home?

*Where will your Golden be housed during the day when you are not home?

Current Pets

*Total number of cats and dogs:

Animal 1: Dog Cat
Age:
Gender:
Male Male Neutered Female Female Spayed

Animal 2: Dog Cat
Age:
Gender:
Male Male Neutered Female Female Spayed

Animal 3: Dog Cat
Age:
Gender:
Male Male Neutered Female Female Spayed

Has any member of your household been cited for leash law violation?
Yes No
If yes, explain:

Has any member of your household been cited for animal cruelty?
Yes No
If yes, explain:

Has any member of your household been convicted of domestic violence, disorderly conduct, child neglect and/or abuse?
Yes No
If yes, explain:

Age Preference:
0-2 3-5 6-8 9-11 12+ No Preference

Gender Preference:
Female Male No preference

Other consideration:
Special Needs Pair of goldens

*Your thoughts on the "perfect" Golden for you/your family:

*Describe your experience with obedience training:

*Further comments you'd like to share with us to help us in selecting the right golden for you, including more about your preferences (i.e. activity level, dog's personality, etc.) and reasons for wanting a Golden:

Have you recently applied to a shelter, humane society or rescue group?
Yes No

If yes, when and which organization?

*Who is your veterinarian?

*Clinic:

*Address:

*Phone:

Do you agree to provide:

Monthly heartworm preventative?
Yes No

Flea/tick treatment?
Yes No

Annual physicals and vaccinations?
Yes No

Regular exercise for your golden?
Yes No

If no to any of the above questions, please explain:

Are all adult household members aware that this application is being submitted and in complete agreement to caring for and training a rescue Golden?
Yes No

List two personal references; only one may be a relative. All should be familiar with your interactions with pets.

Reference 1

*Full Name:

*Relationship:

*Address:

*Best time to contact:

*Home Phone:

Cell Phone:

Reference 2

*Full Name:

*Relationship:

*Address:

*Best time to contact:

*Home Phone:

Cell Phone:

Terms & Conditions
By submitting this application you:

• Understand that GRRoW reserves the right to refuse or deny any application.
• Understand if the information contained herein is found to be false, your application can be refused or said dog adopted shall be relinquished to GRRoW without a refund of monies paid.
• Are at least 21 years of age and living on your own.
• Are financially and physically able to care for a dog.
• Understand that proper food and veterinary care can be costly and you are willing to meet these requirements.
• Are required to make full payment of adoption fee at time of adoption. The adoption fee goes toward the cost of caring for the rescue dogs and is non-refundable.
• Agree to the Hold Harmless clause below.
• Acknowledge that GRRoW makes no warranty about the health condition or temperament of the adopted Golden and that GRRoW can only provide information based on observations at the shelter, statements from the previous owner(s) and evaluation and observation from the foster family or members of GRRoW.

Hold Harmless
Golden Retriever Rescue of WI Inc., herein referred to as GRRoW, (and its officers, board of directors, members and volunteers) shall not be liable to the adoptive family/FWITA/foster home on any theory of legal liability including the sole or concurrent negligence of GRRoW (and its officers, board of directors, members and volunteers), for any injury, death or danger directly or indirectly caused by the rescue Golden Retriever. The adoptive family/FWITA/foster home hereby releases GRRoW (and its officers, board of directors, members and volunteers) from any and all liability, claims, suits, demands, or causes of action which may arise out of or be brought against GRRoW (and its officers, board of directors, members, and volunteers), by virtue of release and transfer of the rescue dog to the adoptive family/FWITA/foster home. It is the expressed intention of the adoptive family/FWITA/foster home and GRRoW that the release provided for in this paragraph is designed and intended to protect GRRoW (and its officers, board of directors, members and volunteers) from the consequences of any attack, behavior or other action by the rescue dog, and from the consequences of any act or omission or negligence on the part of the adoptive family/FWITA/foster home and GRRoW (and its officers, board of directors, members and volunteers) in obtaining custody of the rescue dog, in providing care for the rescue dog, or in failing to provide timely or adequate warning to any person concerning the rescue dog.

*I/We agree to and understand the adoption requirements, terms and conditions, and the GRRoW Hold Harmless clause as stated above.
Type your initials:

Thank you for your interest in Golden Retriever Rescue of Wisconsin Inc.

*How did you hear about GRRoW?
Select One: Public event Friend Family Web site Petfinder GRRoW volunteer Other