First and Last Name *

Email Address *

Phone Number *

Best time to call? *

Full Address (Must include city, state, and zip) *

How long have you been at the listed address? *

What type of home do you live in? *

Please describe your household: *

Own, Rent, Other? *

Landlord's Name and Phone Number

How many adults are in the home and their relationship to you? *

How many children are in the home (ages)? *

Does anyone living in the home have known allergies to dogs or cats? *

Is everyone in agreement on the decision to adopt? *

Do you have other pets in your home? *

If you have other pets in your home, please describe species, age, and breed.

Are these pets up to date on vaccinations? *

Are these pets on heartworm preventative? *

Are these pets spayed or neutered? If not, why? *

Have you ever surrendered a pet? If yes, why? *

Have you ever had a pet euthanized? If yes, why? *

How do you discipline your pets and why? *

Do you have a regular veterinarian? *

Veterinarians Full Name

Veterinary Clinic Name

Veterinary Clinic Address (Must include city, state, and zip)

What is the name of the dog you wish to adopt, If applicable?

What is your idea of an ideal dog and why? *

Desired age, size, breed? *

Desired Gender: *

Willing to Adopt: *

Where will the dog spend the day? *

Where will the dog spend the night? *

Where will the dog stay while you are on vacation? *

Is your yard fenced? *

When the dog goes outside, how will it be supervised? *

Average number of hours dog will spend home alone: *

Who will have primary responsibility for daily care of dog? *

Who will have primary financial responsibility? *

Do you agree to provide regular healthcare by a licensed veterinarian? *

Do you agree to keep the dog as an indoor dog? *

Do you agree to contact Golden Gate Rescue if you can no longer keep this dog? *

Are you willing to allow a representative of GGRC visit your home by appointment? *

How did you hear about Golden Gate Rescue? *

Would you be interested in fostering for GGRC? *

Reference #1 First and Last Name *

Reference #1 Phone number and their relationship to you: *

Reference #2 First and Last Name *

Reference #2 Phone number and their relationship to you: *

Any additional information you would like to provide us with?

I certify that the statements made on this application are true and correct entirely. I understand that any false statements made by me may lead to the rejection of this application for adoption. *

By submitting this application, I agree to hold Golden Gate Rescue Center harmless from and against all loss, cost, liability, damage, expense, penalties, fines, and claims, whatsoever, in connection with the loss of life, personal injury, and/or property damage, arising from the adoption of this animal. *

For adoption purpose: This dog will reside in my home as a pet. I will provide it with quality food, plenty of fresh water, indoor shelter, affection, annual physical examinations under the supervision of a licensed veterinarian. If I can no longer keep this dog, I will contact and return this dog to GGRC. *