Note: All information entered is Private and Confidential
Denotes required field
1. Date Submitted
2. Applicant Information
First Name: Last Name:
Occupation:
3. Co-Applicant Information
4. Contact Information
Address:
City:
State: Zip:
Home Phone: Work Phone:
Cell Phone: E-mail:
5. Household Information
Household Members:
6. Information About Other Pets:
Pet1 (name and type of pet, e.g. - dog, cat, etc):
Gender:
Age:
Spayed/Neutered? (Y/N) :
Pet2 (name and type of pet, e.g. - dog, cat, etc):
Pet3 (name and type of pet, e.g. - dog, cat, etc):
7. Information About Your Home
Do you have allergies to dogs? (checking the box means "Yes")
Are you aware that Golden Retrievers shed? (checking the box means "Yes")
What type of home do you live in? Single Family Apartment Condo Mobile Home
Do you own the home or rent?: Own Rent
Does your home have a Dog door (checking the box means "Yes")
Does your home have a Fenced yard (checking the box means "Yes")
Description of fence:
Description of your yard (grassy, desert, stone, trees, cactus, pools, etc)
Do you have a swimming pool or spa? (checking the box means "Yes")
If so, is it fenced in? (checking the box means "yes")
8. Information About Pet Ownership
Have you owned dogs before? (checking the box means "Yes")
Describe your recent experience with your dogs:
Have you had Golden Retrievers in the past? (checking the box means "Yes")
Why do you want to adopt a Golden Retriever?
Why do you want to adopt a Rescue dog?
Have you ever adopted a Rescue animal before? (checking the box means "Yes")
Describe the circumstances
A very important part of our application revue process is to contact your Veterinarian.
May we contact your Veterinarian? (checking the box means "Yes")
Veterinarian's Name (or Clinic):
Veterinarian's Phone Number:
9. Finding the Right Golden Retriever For You
We would like to find a Golden that best matches your interest. To help us, please provide answers to the following:
What gender do you prefer? Male Female No Preference
On a scale of 1 to 10 (1 = "Gender does not matter at all" and 10 = "Gender is extremely important",
how important is your preference?
What age Golden do you prefer? Less than 1 Yr 1-3 Yrs 3-6 Yrs More than 6 Yrs No Preference
On a scale of 1 to 10, how important is your age preference?
What is your expectation in a Golden retriever?
Protection Companionship Hunting Obedience Agility Don't Know
What type of Golden are you looking for?
Quiet, gentle hearth hound Active, ball-loving bundle of joy Playful, yet restrained
High powered field trainable Don't Know
Are any of the following canine traits displeasing to you? (check only those that apply to you)
Chewing Shedding Jumping Digging Drooling Odor Barking
Would you consider adopting a Golden that had health problems (e.g. - hip dysplasia, etc) (check means "Yes")
Would you consider adopting more than 1 dog (e.g. - littermates)? (check means "Yes")
Would you consider adopting a Golden that required medication for a non-threatening condition? (check means "Yes")
Who will provide primary care for your Golden?
How much will the dog be left alone?
Where would the dog stay when it is home alone?
Do you intend to keep the dog outside at all, if so how much?
Who will care for the dog when you travel?
Will you provide regular exercise for your Golden? (check means "Yes") Describe the type of exercise
Are you aware that Golden Retrievers are considered Large Breed dogs, and as such they have
higher costs than smaller dogs? (checking the box means "Yes")
Would you be willing to take the dog for obedience training, if our adoption coordinator recommends it? (check means "Yes")
Would you crate train the dog if it were suggested? (checking the box means "Yes")
If not, explain
10. Miscellaneous
Have you considered becoming a member of AZGRC? (checking the box means "Yes")
Would you ever consider becoming a Foster Family for rescued Goldens? (checking the box means "Yes")
Where did you learn about AZGRC?
Congratulations - if you have filled out all the information above as accurately and completely as possible, we will be able to process your application more quickly.
A donation to Arizona Golden Retriever Connection is required at the time of adoption. The amount of the donation is as follows:
$300 for Goldens up to 4 years of age $250 for Goldens from 5 to 8 years of age $200 for Goldens 9 years of age or older
$300 for Goldens up to 4 years of age
$250 for Goldens from 5 to 8 years of age
$200 for Goldens 9 years of age or older
The donation amount may be adjusted for very senior or special needs Goldens.
To send in your application, click the Submit button below
Notice - if you click the Reset button, it will clear out all of the information, and your application WILL NOT BE SENT IN.
Notice - we have experienced isolated instances where the applications submitted on-line have not been uploaded to our database. We are working to isolate the problem and correct but, in the meantime, if you submit an application and you have not heard back from us within 5 days of submitting your application, please give us a call at 602-870-0037.