MGCHS Adoption Application

GRACIE’S HEART OF GOLD (GHOG) Adoption Application

PLEASE READ CAREFULLY!!

Thank you for taking the time to fill out our questionnaire. The purpose of this application is to learn a little about your family and home so that our organization can make the best possible match for both you and our animal. Our main concern is placing our animals in a compatible home with a family that will give them a LIFETIME commitment of love and proper care. We realize some of the questions may seem too personal or strange to ask, but we have specific reasons for them based on previous experience in the adoption process. This consultation process is designed to help us determine if the adoption is in the best interest of both the animal and the adopter. Please be aware that while completing this application does not bind you to adopt one of our animals, neither does it guarantee that we will place one of our animals in your home at this time. If you are interested in learning more about one of our rescue animals, please answer the questions honestly and thoroughly.

Some animals may need some extra time and patience to adjust to yet another new home. Some may need housetraining or other types of training, and some may just need a little extra love and patience. All animals, regardless of their background and history, go through an adjustment period when they go to a new environment. There will be a period of a few days, weeks or in some cases months during which your new pet’s personality is emerging and growing while you get to know one another. Please remember that this is a stressful time for an animal and hopefully we will be able to work together to make this a lifetime relationship for you and your rescue pet. You can call on us at any time to help you in any way.

We reserve the right to refuse adoption to anyone for any reason. A representative of GHOG may conduct home visits prior to or following an adoption, and our group has the right to reclaim an animal following an adoption if, unsuitable home conditions, misrepresentation of self, evidence of neglect, abuse or other mistreatment of the animal are found on this visit.

NOTE: We do not ship our animals and/or adopt our animals as gifts. We require a face-to-face meeting.

IN ORDER TO BE CONSIDERED AS AN ADOPTER TODAY, YOU MUST:

• Be 21 years of age or older.
• Have identification showing your present address.
• Have the knowledge and consent of your landlord.
• Be willing to have a rescue representative visit your home by appointment.
• Be able and willing to spend the time and money necessary to provide training, medical treatment and proper care for a pet for the entire life of that animal.

Please initial here to show you have read and understand the process and guidelines. ______

Date: ______

Name/Spouse's Name: ______

Address:______City:______State:______Zip:______

Phone number(s) and type(s): ______

E-mail: ______Best way/time to contact you: ______

Is there a specific dog you are interested in adopting from us? If yes, please indicate the dog's name and tell us why this particular one. If no, please tell us if there is anything specific you are looking for. Also please let us know if you would consider a mix, have a coat color or length preference. ______

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Occupation/Spouse’s Occupation:______

Do you have any children? If yes, what are their ages? ______

Please list the names and ages of people living in the residence: ______

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Do you own or rent?______If you rent, what is your landlord's name & telephone number?______

Do you have a fenced yard? _____ If yes, please tell us the type of fence and how high it is. If no, please tell us if you have

future plans for a fence.______

What pets do your currently have in your household? For each, please give us the following information: Type (dog, cat, etc.), name, age, whether the animal is altered, and whether it is an indoor pet, outdoor pet, or both.______

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Vet Reference: Your veterinarian's name, hospital, city, and phone number: (Vet will be contacted to ensure that past and/or current pets have been kept up to date on vaccinations and heartworm meds, and have been spayed/neutered)______

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Reference #1: Please provide the name, daytime phone #, evening phone # and email address (if possible) of a non-family member who can provide thorough responses to questions about your suitability for this dog: ______

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Reference #2: Please provide the name, daytime phone #, evening phone # and email address (if possible) of a non-family member who can provide thorough responses to questions about your suitability for this dog: ______

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Do any family members have pet allergies, if so please provide details regarding specifics and severity______

Do any family members or children’s friends have any fear of dogs/puppies?. If so please provide details regarding specifics, & severity ______

Why have you decided to adopt a dog/puppy?______

Will this be your first dog/puppy?______

What other animals have you owned before?______

Have you ever: lost a pet, surrendered a pet to a shelter/rescue, given a pet away or placed a pet in another home? If so, please explain ______

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Have you had any puppies/dogs in your household within the past year with parvo, distemper, kennel cough, mange, or coccidia? If so please explain how long ago, what treatment provided final outcome ______

Have your past/current pets been kept up to date on annual vaccines and been tested for heartworm? ______

Are your current pets on heartworm preventative? ______What form of preventative have you used (are you using) for your past and/or current pets? ______

Is someone home during the day? ______Longest number of hours expected to be gone at one time ______

What are the work hours of all household members?______

Where will your pet be kept during the day? And at night?______

Who will be the dog’s primary caretaker?______

Please describe your exercise plan for the dog/puppy______

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Describe your house-training method ______

Are you willing to obtain a crate and crate-train the dog if necessary?______

Have you had any training experience?______

Are you willing to take the dog to a basic obedience class if necessary?______

What would you do if the dog bit somebody? ______

Excluding your death, what conditions or circumstances would cause you to give up an animal? ______

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What arrangements have been made to ensure your pets will be cared for if something would happen to where you were no longer able to care for them or in the event of your death? (sorry to have to ask this question!)

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(Please be willing to provide this contact information should the adoption be approved so we can keep this information on file.)

Questions or additional comments to help us determine adoption approval.______

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Please type your name here to serve as signature to this application: ______

INTERNAL USE ONLY: Date:______Interviewer:______Dog/Puppy of Interest:______ID#______

Discuss: Experience level with dogs/ training/vet care and expense/grooming/exercise: _____ What would do if had to move/new relationship:______

Overall impression of all interested parties: ______RF?______Willingness to work with animals?: ______

Check and rate references? 1)______2)______3)______

Signature of interviewer(s):______Approved?______If no, reason?______