Contact Information

Last Name     First Name:

Co-Applicant Name

Street Address

City State   Zip

Home Phone

Cell Phone
Cell Phone
E-Mail

Employment

Your Employer
Position
Work Phone

Co-applicant's Employer
Position
Work Phone

Living Arrangements

Do you live on a busy street? Yes No

Describe your area:

Is your yard fenced? Yes No

Describe your fence:

Do you own or rent? 

If rent, please provide landlord's name and phone number:


Do you have the permission of your landlord to have the dog? N/A Yes No

As part of the application process, , a member of our adoption committee will visit you in your home.  When is the best time for a home visit by MAGRR?

Do you have a valid drivers license and a vehicle suitable for transporting a Golden Retriever?

Do you have a swimming pool? N/A Yes No  

Do you cover your pool? N/A Yes No  

If you cover your pool, please describe the cover?

 

About the Family

Do you have any children? N/A Yes No  

Please give ages of all members of the household:

Do they or other family members live with or visit you? N/A Yes No

Please list any additional pets you have in your household:

  Species Dog Cat No Current Pet Bird Rabbit Other Breed Name Age Sex (select one) Male/Neutered Female/Spayed Male Female

  Species Dog Cat Bird Rabbit Other Breed Name Age Sex (select one) Male/Neutered Female/Spayed Male Female

  Species Dog Cat Bird Rabbit Other Breed Name Age Sex (select one) Male/Neutered Female/Spayed Male Female

  Species Dog Cat Bird Rabbit Other Breed Name Age Sex (select one) Male/Neutered Female/Spayed Male Female

  Species Dog Cat Bird Rabbit Other Breed Name Age Sex (select one) Male/Neutered Female/Spayed Male Female

  Species Dog Cat Bird Rabbit Other Breed Name Age Sex (select one) Male/Neutered Female/Spayed Male Female

Please tell us about ALL pets you have had during the past 5 years...
Where are they now?

Does anyone in your household have allergies? Yes No  

If so, please tell us what kind of allergies?

Do all members of your household want to share their lives with a rescued golden? 

It's a Golden's Life

Who will be the primary caregiver for the dog?

Is the primary caregiver physically limited in his/her ability to properly care for and exercise a golden retriever? Yes     No
If you have physical limitations, please share that info with us so that we are more fully able to find an appropriate match for you.

Why do you want to adopt a rescue golden?

Tell us a bit about your experience with Golden Retrievers:

For which of the following reasons would you give up your dog? (select all that apply)
moving                                    not housebroken
divorce                                    gets too big
shedding                                  not getting along with other pets
allergies                                   behavior problems
barking                                    increase in work schedule
aggressive                                medical problems
new baby                                  not getting along with children
getting out of fence                  none
children have lost interest         other (list please)

What will you do if you are faced with an unexpected vet bill of $1,000 or more for a treatment required to save your dog's life? (select all that apply)
credit card                                    work out payment plan with vet
take out a loan                              I would not do the treatment
turn in to shelter                           give dog back to MAGRR
ask MAGRR for financial help         put the dog to sleep
money is not a problem                 other (tell us your plan in the space below)

What amount of time do you think is reasonable for a dog to adjust to your family and environment?

How did you hear about MAGRR?

How long daily will the dog be left alone (without humans)?

Where will the dog stay when you are away from the house?

Will the dog be allowed in the house? Yes No  

Which parts?

Where will he/she sleep at night?

Where will he/she spend the day?

What will you do with your golden is you go on vacation?

What will you do with your golden if you are relocated?

What do you think about tying a dog up outside?

Are you familiar with the use of a dog crate to train the pet during your absence or at night? Yes No

Are you willing to crate train if necessary? Yes No

Will the dog have formal obedience training? Yes No If Needed

If yes, please provide the name and number of the trainer

Are you aware that goldens love to be with their humans, and are you willing to devote as much time as possible to the newest member of your family?

Are you aware that the average cost per year for care and maintenance of a golden is at least $1,000.00?

Who will groom your rescued golden?

Are you aware that goldens need their ears cleaned and nails trimmed on a regular basis?

Are you aware that goldens shed all year long and require frequent brushing?

Please provide the full name, address, and phone number of your current veterinarian (PLEASE notify your vet's office that a representative for MAGRR will be calling and that you want them to release information to us):

Name

Phone

Street Address

City State Zip Code

Where do you purchase heartworm preventative medication if not from your veterinarian?

I authorize MAGRR to contact my veterinarian

Are you familiar with your local licensing and leash ordinances?

Have you sold, given away, or surrendered a pet to a shelter? Yes No

 If so, please explain:

Have you, or any member of your family/household been cited for leash law violations or cruelty to animals in the past? Yes No  

If so, please explain:

We are interested in...

What sex are you interested in? Either Male Female

What activity level would best suit your family? Low Moderate High

Will you consider a:

Special Needs Golden
Senior Golden (8 or older)
Mixed Breed Golden

Have you applied to any other rescue groups? Yes No

If so, which ones?

Feel free to make any additional comments:

If you golf, would you be interested in being a part of our annual golf tournament? Yes Out of Memphis Area No

If you are a runner or jogger, would you be interested in participating in our annual 9K9 run/walk? Yes Out of Memphis Area No

Do you understand that...

...you are making a commitment to love and care for this golden as long as he/she lives?

...the adoption fee for a MAGRR dog is $250.00?

...we will do our best to find a Golden that matches your preferences, but that our first priority is matching the right personality with the right home?

...if you do adopt a MAGRR Golden, you are to return the golden to MAGRR if you are unable to keep or care for him/her for any reason?

...you should NEVER take this Golden to a shelter, pound, or humane society, and that you should never give this Golden to someone else?

Thank you for submitting your application.  You will receive a confirmation email after hitting the submit button.  We appreciate your willingness to help MAGRR, and our goldens in need.  We will begin reviewing your application shortly.

MAGRR Coordinator Comments: