ADOPT – Emerald Coast Golden Retreiver Rescue

ECGRR – Application For Adoption

The information you enter here will help us match up potential dogs available for adoption
with your home environment and lifestyle. Please keep this in mind as you complete the
application. We make adoption decisions/placements based on what is best for the dogs
in our care.

Please note: * indicates a required entry

Incomplete/partially completed applications are purged from our system after 24 hours.

First Name
Last Name
Address
City
State
Zip Code
Phone	Your primary contact number
Work Phone
Cell Phone
Email
Best time to call
Referred to ECGRR by	Referred to ECGRR by Internet Friend Family Co-worker Previous Adopter News Media other:
Residence status	Residence status Own Rent other: Do you own or rent your home?
Property Description	Briefly describe your property. Example: fenced back yard, lot size, stairs, etc.
Time at Residence	How long have you lived at this address?
Ages of household members	Separate with a comma (i.e. 40,39,10)
Household activity level	Household activity level Very Active Active Moderately Active Calm other:
Family Allergies or Medical	Family Allergies or Medical Yes No Is there anyone in the home that has allergies or other medical conditions that need to be taken into consideration before adopting a dog?
Familiar dog breeds	Briefly describe the breeds you are most familiar with. Example: labs, poodles, goldens, shepherds, …
Prior Pets	Briefly (in 20 words or less) list all prior pets you have had.
Prior Likes	Briefly explain what you like most about dog ownership?
Prior Dislikes	Briefly explain what you like the least about dog ownership?
Current pets	Current pets NONE Female dog(s) Male Dog(s) Small dog(s) Cat(s) Bird(s) other: Please indicate current pets in your household.
Reason for Adopting	Briefly (in 20 words or less) explain why you would like to adopt a rescued dog.
Adopt before meeting dog.	Adopt before meeting dog. Yes No Would you adopt a dog without meeting it first?
Interested in Dog	Was there a particular dog you were interested in? If so, please list the name and ID # here.
Gender	Gender Male Female No Preference Please list the gender of the dog you would like to have.
Age Range	Age Range Under 1 yr old 1 to 4 yr old 4 to 6 yr old 6 or Older Senior No Preference Indicate the age range(s) of the dog you would like to adopt. Multiples may be selected for a larger range. Example: If interested in a 1-6 yr old, select both 1 to 4 yr old and 4 to 6 yr old
Mix or Pure	Mix or Pure GRP-Golden Retriever Pure GRM-Golden Retriever Mix LRP-Lab Retriever Pure LRM-Lab Retriever Mix Doesn’t Matter Please indicate if you would be interested in a pure or mix breed. Multiple selections can be made.
Special Needs	Special Needs Yes No Maybe Would you possibly adopt a special needs dog? Examples could include: physical/medical conditions like limited sight/hearing/mobility/health restrictions – Behavioral problems like separation anxiety/thunderphobia – A senior dog that requires special assistance
Past Surrenders	Past Surrenders Yes No Have you ever surrendered any past pets to a shelter or rescue organization?
Primary care of the dog	Who will be primarily responsible for the dog?
Any problems with adding a dog	Any problems with adding a dog Yes No Unknown Do you foresee any problems with adding another pet to the home?
How long will dog be alone	How long will dog be alone Almost None About 4 hours daily About 8 hours daily Varies daily other: Select the best choice.
Where will dog stay at your home?	Where will dog stay at your home? Outdoors Indoors other:
If required to move – what about the dog?	If required to move – what about the dog? With Us Give to a family member Give to a friend Give to a local shelter No plans to move other:
Heartworm preventative	What type will be used? If unknown then type “unknown”. Heartworm disease is serious and potentially fatal to pets. We require all adopted dogs to be tested annually and be on a regular preventative.
Vet name – address	Please list the name, address and phone number of your current vet. If you do not have one, please indicate a veterinary service you will most likely use.
Understand regulations	Understand regulations Yes No Do you understand your local laws and regulations for pets?
Signature applicant	Full typed name
Signature co-applicant	Full typed name of co-applicant

After you click the button to submit your application a confirmation page will be
displayed and a confirmation email will be sent to you.