Memories Golden Retrievers
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ADOPTION APPLICATION
Golden Moments Rescue
(Print out this form)
Complete, Sign & Send To:
Athena Brown
2003 Sage Road
Casper, WY 82604-1867
PERSONAL INFORMATION Name of Applicant: ______________________________________________________________ Name of CO-applicant (adults over 18 yrs. only): ______________________________________________________________ Relationship to Applicant: ______________________________________________________________ Address:_______________________________________________________ City, State, Zip:________________________________________________ Phone: Home (____)________________ Work (____)_________________ E-mail______________________________________________________ Applicant's Employer Job Title: _____________________________________________________________ How did you hear about Golden Moments Rescue?_______________________________________________________ DOG PREFERENCES (This information will guide us in finding the Golden best suited to your situation. Applicants should understand that the more latitude indicated here, the higher the potential for finding a dog in the shortest period of time). Sex________ Prefer:____ Require:_____ If you answered "require," please explain: ______________________________________________________________ AGE________ Prefer:_____ Require:_____ If you answered "require," please explain: ______________________________________________________________ Would you consider a dog: Older than 3 years? _____Older than 5 years? ______ Please list, in order of importance, the attributes you are seeking in a dog: a._____________________________________________________________ ______________________________________________________________ b._____________________________________________________________ ______________________________________________________________ c._____________________________________________________________ ______________________________________________________________ 1. Please explain why you want to adopt this animal: ______________________________________________________________ ______________________________________________________________ HOUSEHOLD & DOG CARE INFORMATION (circle one) Do you live in a: House Townhouse Apartment Duplex Condo Do you: Own Rent Do you have a fenced yard? Yes No What type of fence? ______________________________________________________________ If you do not have adequate fencing (i.e., a totally enclosed, secure fence), how will you provide exercise for the dog?__________________________________________________________ How many adults in household?_____ Children?_____ Ages:________ Who will be responsible for the care of this pet?_____________________ ______________________________________________________________ Where would the pet be kept during the day?_____________________ ______________________________________________________________ Signature of Applicant: _______________________________________Date___________________ Signature of CO-Applicant: _______________________________________Date___________________ |