Instructions
To be considered for placement, you must check and agree to all terms and conditions of adoption with WAAGR.

*ALL HIGHLIGHTED FIELDS ARE REQUIRED

Applicant Information

Applicant Name		Date of Birth		Month 1 2 3 4 5 6 7 8 9 10 11 12 Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908		MaleFemale
Co-Applicant Name		Date of Birth		Month 1 2 3 4 5 6 7 8 9 10 11 12 Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908		MaleFemale
Address		State	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY	City		Zip Code
Do you own or rent?	Own    Rent

Contact Information

Primary E-mail		Primary Phone
Secondary E-mail		Seconday Phone
When is the best time to reach you by phone?		A.M.  P.M.  Email preferred

Other Family Members and Frequent Visitors
List all other members of the family and frequent visitors in the primary residence.  List issues that may affect the ownership and care of having a resident dog.  (e.g. allergies, elderly, etc.)  You will have an opportunity to tell us more about additional members of the household.

Name	Age	Male Female	Health
Name	Age	Male Female	Health
Name	Age	Male Female	Health
Name	Age	Male Female	Health
Name	Age	Male Female	Health

Family Pets
List all pets in the household.

Name	Age	Type	Health
Name	Age	Type	Health
Name	Age	Type	Health
Name	Age	Type	Health
Name	Age	Type	Health

Personal References
Please Provide two personal references.

Name	Relationship	Phone Number
Name	Relationship	Phone Number

 

*ALL HIGHLIGHTED FIELDS ARE REQUIRED

About Your Home
Tell us about your home and family.  This information will help us to find the ideal dog for your family.

Have you ever owned a Golden Retriever?  Why do you want a Golden Retriever?
 

Who will be the primary caretaker of your new dog?  Do all members of the family want a dog?
 

Where will the dog spend his/her days?  His/her nights?  How long will the dog be left alone on a daily basis?
 

Do you have a fenced yard?  How high and what type?  How will you exercise and socialize your dog?
 

What brand of food will you feed your dog?  Where and when will you feed him/her?
 

Have you ever sold or given away a pet?  If yes, please explain.
 

Have you had any pets that died?  If yes, please explain.
 

Will you walk the dog daily?	Yes	No
Are you aware of the high cost of owning a dog? ($500-1000/year)	Yes	No
Will you take your dog to training classes?	Yes	No
Are you willing to crate train your new dog?	Yes	No
Will your dog be allowed on the furniture?	Yes	No
Are you aware that Goldens shed year round?	Yes	No
Did you know that Goldens are a large breed and can knock down children?	Yes	No
Will you groom the dog?	Yes	No
Will you use a groomer to keep the dog groomed?	Yes	No

Veterinarian Information
If you currently have a veterinarian for your pets, please provide his or her information.

Doctor Name
Clinic Name
Phone Number
Address
City		State	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY	Zip Code
May we contact your vet for information regarding your pets vet care?						Yes  No

Golden Preferences
Tell us about the Golden Retriever you are looking for.  This information will helps us start searching for your ideal dog right away.  You will have opportunities to discuss your preferences in more detail during the interview process.

*What age will you consider?	*Which Gender do you prefer?	*Would you also consider?
Puppy to 2 Years Age 2 to 4 Years Age 4 to 6 Years Age 6 and Older	Female Male Either	Fostering with the intent to adopt. A senior dog. A Golden mix breed. A special needs dog. A pair that will not be separated.

Application Fee
Because WAAGR depends solely on donations for our VOLUNTEER work, we find it necessary to request an application fee of $25.00 to help offset the cost of phone calls and postage in processing the application.  Additional donations are graciously accepted to offset the cost of veterinary care for the dogs in foster care.

I wish to be contacted to act as a volunteer for WAAGR.

I authorize my veterinarian to release all vet records about my pets.

*I understand that my application with WAAGR does not guarantee adoption. (Required for your application to be accepted)

 

 

Adoption Fee	Adoption Fees
Adoption fees are not tax deductible.  All adoption fees are subject to a 5.6% WI state sales tax.  Do not send adoption fees with this application.	Age Puppy to 5 years	$275.00 (+ $15.13 Sales Tax)
	Age 6 to 9 years	$225.00 (+ $12.38 Sales Tax)
	Age 10 years and up	$125.00 (+ $6.88 Sales Tax)
Additional donations are tax deductible and will be applied directly to vet care of dogs in foster care.	Pair of dogs to 9 years	$375.00 (+ $20.63 Sales Tax)
	Pair of dogs 10 and over	$150.00 (+ $8.25 Sales Tax)