Apply for Adoption

Contact Information

Application Date
First Name*
Last Name*
Spouse/Partner Name (full name please)
Your Address*
City*
State
Zip Code*
Home Phone # xxx-xxx-xxxx
Work Phone Number # xxx-xxx-xxxx
Cell Phone # xxx-xxx-xxxx
Best number to contact* Home Work Cell
Email address
2 Major Cross Streets
Are you currently a member?* Yes No
If so Date Joined (mm/dd/YYYY)?
When would be a good time for us to come for a home visit?*
How did you find out about Arizona Golden Rescue?*
- AGR Public Appearance
- AGR Member
- Social Media (Facebook, Yahoo Groups, etc.)
- Internet Search
- Pet Search Site (Petfinder, Adopt-a-Pet etc)
- Other
If at a Public Appearance, please select location
- PetSmart Tempe Marketplace
- PetSmart 7290 W Bell Rd Glendale
- PetSmart 7077 E Mayo Blvd Scottsdale
- PetSmart 91st Av & Peoria Glendale
- PACC911 Adopt-a-Thon
- Other Public Appearance
If other, please indicate where you saw us
If recommended by an AGR Member, please tell us who

Household Info

Type of Home*
- Single Family Home
- Condo or Townhouse
- Apartment
- Mobile Home
- Motor Home
- Other (please describe below)
Describe Other
Do you own or rent? (Please be advised that if the home is a rental we will need to have written permission from the landlord to allow a Golden to be placed in the home.)* Own Rent
How long have you lived at current address?* Less than one year One to Five Years More than Five years
If less than 1 year, what was your previous address?
Previous City
Previous State
Previous Zip Code
Renters: Do you have permission to keep a golden retriever? If yes, you must provide a copy of written permission prior to the home evaluation Yes No
Are there stairs in your home?* Yes No
If yes, please describe
What type of flooring?*
- Carpet
- Glazed Tile
- Unglazed Tile
- Linoleum
- Wood
- Concrete
- Combination (describe)
Describe Combination
Is your yard fenced?* Yes No
Fence Height
Fence Material
- Block
- Wood
- Chain Link
- Other
Describe the fencing
Does fence completely enclose the back yard?* Yes No
Are gates kept latched or locked?* Yes No
Describe your yard*
- Grass
- Gravel
- Trees
- Cacti
Do you have a spa?* Yes No
If yes, is it covered when not in use? Yes No
Do you have a swimming pool?* Yes No
If yes, is it fenced? Yes No
If yes, describe the fencing:
Are you aware that most Golden Retrievers enjoy swimming and if you have an unfenced pool, the Golden will most likely swim in it? Yes No
Will you allow the Golden to use the pool? Yes No
How do you plan to train the Golden to get out of the pool?
Do you have a doggie door?* Yes No
If no, would you be willing to install one? Yes No
If no, why not?
Are you employed outside the home? Yes No
How many hours a day are you away from home?
Is your spouse employed outside the home? Yes No
How many hours per day is (s)he away from home?
Do you have children or grandchildren who live with you?* Yes No
Ages of children
- Under 3
- 3-12
- Over 12
Do you have children or grandchildren who visit frequently?* Yes No
Ages of children
- Under 3
- 3-12
- Over 12
Are all pets up to date on their vaccinations?* Yes No
If no, explain why:
Do you have any immune-compromised pets or family members in your household? Yes No
Any special-needs pets or family members in your household?* Yes No
Do any family members have allergies?* Yes No
If yes, what kind:
If you currently have other pets, please describe breed, age, and gender of other pets. If there are no other pets just enter none.*
Name and phone number of local vet you have used:
What type of vehicle(s) do you own? Please be specific e.g. Ford Escort, Dodge Caravan, Chevy Extended Cab Pickup, etc.)*
How will you transport the dog in a vehicle? (loose in the vehicle, tied down in the vehicle, behind in a crate, etc.) Please note, AGR will not allow dogs to be transported in the back of a pickup even if confined to a crate)
How often do you travel?
When you travel, where will the golden be?* With us With petsitter at our home At Friend's House With Trainer With Groomer Boarding at Vet boarding at Kennel Other (specify)
Specify Other:

Golden Preferences

What gender do you prefer?* Male Female Either
Age preference? Please note: It is the policy of AGR not to place a dog under 3 years of age with a family that has children under the age of 3 years of age.*
- 0-2 yr
- 2-5 yr
- 5-9 yr
- 9+ yr
Consider a golden mix?* Yes No Maybe
Consider a pair?* Yes No Maybe
Would you consider a dog with mild health problems easily treated with medication such as valley fever, hypothyroid, mild allergies, mild arthritis?* Yes No Maybe
Would you consider a dog with major health problems such as an epileptic, diabetic, dog with severe allergies or cancer?* Yes No Maybe
Consider a senior dog (over 9)?* Yes No Maybe
Will the dog live inside the home?* Yes No Maybe
Do you think that an active dog will annoy you? Yes No
Will it annoy you if the Golden gets up on your sofa or bed? Yes No
If yes, how would you train the dog to not get on the furniture?

Experience with Pets

I consider myself: An experienced golden retriever person An experienced dog owner Somewhat experienced with dogs Novice dog owner
If you never had a golden, why do you want one now?
Have you rescued a dog before? Yes No
If yes, from what rescue organization?
If no, why do you want to foster/adopt a rescue dog?
Have you ever had to relinquish a dog? Yes No
If yes, what were the circumstances?
How will you exercise the golden?
- Daily walks
- Fetching
- Jogging
- Hiking
- Swimming
- Run free in back yard
- Dog park
- Other (describe)
Describe other:
Can you afford the cost of caring for a Golden? Yes No Maybe
Willing to take your Golden to a vet for annual physical and vaccinations? Yes No
Willing to have your golden tested annually for valley fever? Yes No
Willing to have your golden tested annually for heartworm? Yes No

Training and Behavior

If recommended by AGR would you agree to take dog to obedience classes?* Yes No
Have you completed an obedience class with a previous dog?* Yes No
If yes, what were the training techniques you learned?
Understand that goldens are a large breed and some may need training?* Yes No
Agreeable to crate training?* Yes No
If no, why not?
A rescued Golden may have one or more of the following behaviors. Please tell how you would handle such behaviours:

Handle Barking*
Handle chewing?*
Handle digging?*
Handle drooling?*
Handle jumping on people?*
Handle shedding?*
Some Goldens have been backyard dogs and are therefore not housetrained. Have you ever housetrained a dog?* Yes No
Are you comfortable with having to housetrain a Golden?* Yes No
If not housetrained, what house training methods do you plan to use?
Even some housetrained Goldens will have accidents in the house for awhile after they come into an unfamiliar home. What steps will you take to help your golden avoid such accidents?*
Some Goldens have been left in backyards by neglectful or untrained owners and may have developed anxiety to thunderstorms or loud noises in general. Have you ever dealt with a dog with "noise anxiety"?* Yes No
If NO, are you willing to read some information on behavior modification and work with the rescued Golden to overcome such anxieties? Yes No
Due to their "history", some Rescued Goldens have developed separation anxiety. Have you ever dealt with such a dog?* Yes No
If NO, would you be willing to read some information on behavior and work with the dog to overcome this problem? Yes No
Willing to learn / correct submissive urination?*
Some rescued Goldens come from physically abusive homes and are extremely timid and have a condition called "submissive urination". Usually this condition lasts only a few days. Once the Golden knows he is in a home where he will not be beaten or abused and his self-esteem and confidence return, this problem usaually takes care of itself. However, if it does not, are you willing to read some information on behavior modification to help the Golden overcome this condition?
Yes No

General Agreement

General Agreement*
- I/we am/are at least 21 years of age. All of the information I/we have given is true and complete. I/we understand that Arizona Golden Rescue has the right to refuse my/our application.
- All household members are in complete agreement to foster and/or adopt a rescued Golden Retriever.
- I/we understand that as a foster or FWITA, I/we are responsible for providing a good quality dog food, for absorbing the cost of any toys or treats should we choose to purchase any, and covering any transportation costs to and from vets when necessary.
- Approved vet care, prescription dog food and medications will be paid for by AGR as long as the dog is in foster care (i.e., until adoption is finalized).
- I/we understand that Arizona Golden Rescue remains co-owner for the life of any Rescued Golden that comes through the AGR program.
- Arizona Golden Rescue has the right to reclaim any foster or adopted Golden if the Executive Board of Directors feels that doing so is in the dog’s best interest.
- I/we understand that I/we must pay the adoption fee by check or credit card at the time the rescued dog is delivered to my/our home.
- If, after a 21-day settling-in period, I/we choose not to adopt this dog, I/we understand that the adoption fee will either be refunded or will be applied towards the adoption of another AGR rescue.
Applicants Signature (By typing/entering my name, I intend to affix my electronic signature)
Date
Spouse's signature (By entering my name, I intend to affix my electronic signature)
Date