Adoption Application
NOTE: We are able to accept applications only from persons living in the state of Ohio.

Section One

Date:

Name:

Age:

Address 1:

Address 2:

City:

State:

Zip:

County:

Day Phone:

Alt. Phone:

Best time to call:

Email Address:

Section Two

1. Is this an application to?
   ---Select One--- Foster Adopt

2. Our Goldens vary in age. What age will you consider?
   ---Select One--- 0-3 Years 3-6 Years Any Age

3. Which do you prefer?
   ---Select One--- Either Female Male

4. Would you consider a special needs Golden?
   ---Select One--- Yes No i.e., requires medication

5. On a scale of 1-5, with 5 being a highly energetic dog and 1 being a very quite dog, what activity level are you looking for in this adoption?
   ---Select One--- 5 4 3 2 1

6. Will you consider a golden mix?
   ---Select One--- Yes No

7. Will you consider a pair?
   ---Select One--- Yes No

8. When will you be actually be ready to receive a new dog?

Section Three

1. Have you previously had pets?

     ---Select One--- Yes No

2. If you answered yes to the above question
   please describe the
   pets previously in your home?

3. Are there other pets in your
   home currently?
   ---Select One--- Yes No
4. If you answered yes to the above question
   please provide the age and type of the
   pets in your home?
   
5. Are your existing pets spayed/neutered?
   ---Select One--- Yes No
6. If no, please explain:
   

Section Four

1. Children in your
   Home?
   ---Select One--- Yes No
2. Ages and Sex of Children?
   
3. Have they been raised with a dog
   previously?
   ---Select One--- Yes No
4. Have they been taught to respect an
   animal as a living thing and not a toy?
   ---Select One--- Yes No
5. Rate your child(ren's) behavior
   with pets:
   ---Select One--- Excellent Good Rair
6. Other people who will be living with
   the dog?
   
7. Is this dog for an:
   ---Select One--- Adult Child Elderly Person Challenged

Section Five

1. Do you live in a:
   ---Select One--- House Condo Apartment Duplex (You may be asked to provide a letter from a landlord stating that this dog is allowed in the complex for condos, apartments and duplexes.) 

2. Do you own this property?
   ---Select One--- Yes No

3. Do you presently have a completely
   fenced-in yard?
   ---Select One--- Partial Yes No

4. If no, how will the dog be managed
   outside?
   

5. If by fence, what type/height?
   

6. Approximate yard size?
   

7. Where will the dog be kept during
   the day?
   

8. Where will the dog be kept during the
   evening?
   

9. Will your dog be allowed on the
   furniture/bed?
   ---Select One--- Yes No

10. Will he/she have the run of the house?
    ---Select One--- Yes No

Section Six

1. Are you an active individual?
   ---Select One--- Yes No

2. What will you do with your dog when you
   are on vacation?
   

3. Have you ever sold, given away or put a
   pet into a shelter?
   ---Select One--- Yes No

4. If so, explain circumstances:
   

5. Does anyone in your home have allergies
   to pets?
   ---Select One--- Yes No

6. Will you use a crate?
   ---Select One--- Yes No

7. How will you provide the exercise that
   this dog requires?
   

8. Do you plan to train your pet yourself or
   take it to an obedience school?
   

9. If you plan to take it to school, which
   one?
   

Section Seven

Please list the name, address and phone number of any previous vets you've used:

Present Vet
Name:

Address 1:

Address 2:

City:

State:

Zip:

Phone Number:

Previous Vet
Name:

Address 1:

Address 2:

City:

State:

Zip:

Phone Number:

 

May these individuals be contacted regarding past or
present pets and any dog you may obtain through us?
---Select One--- Yes No
PLEASE CONTACT YOUR VET WITHIN 1 BUSINESS DAY OF SUBMITTING THIS APPLICATION TO GIVE PERMISSION FOR GOLDEN TREASURES TO HAVE ACCESS TO CURRENT AND PAST PET MEDICAL RECORDS.  IF WE CONTACT YOUR VET AND THEY DO NOT HAVE YOUR PERMISSION TO RELEASE RECORDS, WE WILL REJECT YOUR APPLICATION. 

Who referred you to us?

Section Eight

The Golden retriever is a wonderful dog; however, they are predisposed to several conditions:  ear infections, hot spots, excessive shedding, and they generally need lots of exercise in order to be good house pets.  Many require a good amount of attention and when not given the attention they wish, will resort to tearing up your favorite slippers, gardens, etc. in order to get that attention.  These dogs are excellent obedience candidates and can be easily trained to be wonderful companions, if you will work with them.  Obedience is obtained by being fair, consistent and by offering praise when the deed is obtained.  To train a dog, you have to think like a dog.  Hitting, slapping, kicking etc. is considered as aggression by the animal and eventually the animal may retaliate.  This dog will cost approximately $150 annually in vet bills, $160 to feed, and additional expenses may include grooming, collars, leashes, bowls and toys.  We want both of you to be thrilled with each other and would be glad to help in any way to insure this. We will be in periodic contact with you to insure that all is going well.

Our dogs have all received current veterinary care:  rabies update, DHLPP update, fecal exam, heartworm exam and initial protection, spay/neuter, bordetella vaccine and other tests as indicated by a general health check-up.  You will, however, need to purchase additional heartworm preventative for year-round use.

The cost of one of our dogs is $225.00 for dogs up to 8 years of age and $75.00 for dogs 8 and older.  Special needs dogs will be placed free of charge into caring homes.  Checks should be available at the time of the adoption.

I have read and completed the above to the best of my knowledge.