PLEASE PRINT  ALL INFORMATION

First Name: ____________________   Last Name: __________________________________
Street address:______________________________________________________________
City: ____________________________________ State _______________ Zip_____________
Home Phone: _____________________Work Phone(s): ___________________________ Cell Phone_____________________________________
Email Address: _________________________________

A complete answer to the following questions will enable us to be more familiar with your request and requirements, and will help us find the Golden Retriever to match your needs and expectations.

Do you have any children? ______  Please give their ages: ____________________________
Do they or other family members live with or visit you?  ________________________________

Does anyone in your household have allergies?  ______    If Yes, to what allergens? ________
May we visit your home prior to application approval? _____    If Yes, when ? ______________
Please list all the pets you currently own:
    Species   Sex     Spayed/ Neutered     
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

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__________
City_____________________________________ ST__________ZIP________

Where do you purchase heartworm preventative for your dog if not from your veterinarian_________________

How long have you lived at your current address? ___________  Do you own _____/ rent____?
If rent, please provide landlord's name and phone number:  ___________________________________________________________________________

Do you have the permission of your landlord to have a dog?______ Up to what size?________

Will the dog be allowed in the house?____________  How long daily will the dog be left alone (without humans)? _____________
Where will the dog stay when you are away from the house? _______________________
Will you be willing to bring your foster dog to scheduled adoptathons? ____________

Will you be willing to take you foster dog to any vet appointments if scheduled at your convenience? ________________

Are you familiar with the use of a dog crate to train the pet during your absence or at night?_________       Is
your yard fenced? ______ Type fence ?____________ Height _____ Width ______ Length_______ Approx. size
of dog's yard area _______ Will the dog be walked daily? _______  Exercised in a fenced yard? ________
Allowed to run free without supervision?_______  

Have you ever owned a Golden Retriever? ______  Are you aware that Goldens are active and that they
shed all year long?  _____________

Have you sold, given away, or surrendered a pet to a shelter? ____  If Yes, please specify _ ________________________________________________ ___________________________

Please tell us a little of your lifestyle, your family including any special activities in which your foster dog
would be included.  (If you have any special requirements or requests for a dog, please let us know so that
we can more carefully match a dog to your lifestyle)
______________________________________________ ________________________
___________________________________________________ _______________ ____
________________________________________________________ ______________

Have you, or any member of your family/household been cited for leash law violations or cruelty to animals in the past? ___________
If YES please specify:__________________________________________________________

Please tell us how you became aware of MAGRR and its programs. ___________________________________________________________________________________

Are you a golfer?__________________________

Are you are runner/jogger?__________________

 
Please return this form  to:
Memphis Area Golden Retriever Rescue
P. O. Box 383122
Germantown, TN 38183-3122
Fax: 901-752-1519

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