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Contact Information (*=required)

First name*   
Middle name 
Last name* 
Company name 
Address (line 1)* 
Address (line 2) 
ZIP or postal code* 
Address type 
At least one required
E-mail and type* 
The Contact Information above should be for the Primary Applicant.

SCGRRescue adopts to homes throughout the Southern California region.

To help cover expenses, SCGRRescue requests a donation at the time of adoption of:

$500 for dogs 0 to 1 year old.
$400 for dogs 1 to 4 years old.
$350 for dogs 4 to 6 years old.
$300 for dogs 6 to 8 years old.
$250 for dogs 8 years and older

Please repeat all contact information below as the information above does not appear on the filed and printed form.

1. Name:
2. Co-Applicant Name:
3. Address:
4. City:
5. State:
6. Zip Code:
7. Email Address:
8. Home Phone:
9. Cell Phone:
10. Work Phone:
11. Occupation:
12. How long have you lived at your current address?
13. Do you rent or own?
14. If you rent, do you have written permission from landlord? (Please be prepared to show that at your in-home interview.)
15. How many people live in the home?
16. Are there any minor children? if yes, please list their ages.
17. Do other young children visit your home? What ages?
18. Do you have a securely fenced yard? What type of fencing do you have?
19. Do you have a pool the dog can access? Is it separately fenced?
20. What pets do you currently have? (type, age, altered, indoor pet, etc.)
21. Aside from your current pets, what other pets have you had in the last ten years? Please tell us the type of animals and why they are no longer with you.
22. What is your veterinarian's name, hospital, city and phone number?
23. What is the dog or pet limit in your city, county or HOA?
24. Does anyone in your home have pet allergies?
25. Tell us why your family wants a Golden Retriever. Are you considering any other breeds?
26. Would you like a Golden for a house pet, guard dog, companion?
27a. Describe the features of the Golden Retriever you would ideally like to adopt; male, female, age range, energy level, etc
27b. Which Goldens on our website, if any, appeal to you?
28. How much exercise would your Golden get? Please describe:
29. How many hours each day will your Golden be without human companionship?
30a. Where will your Golden be kept during the day?
30b. Where will your Golden be kept at night?
31. How will you confine your Golden to your property? For Example: in the house; crated; fenced yard; chained; in the garage; other;
32. How long do you feel your new Golden Retriever should be given for an adjustment period?
33. What type of training classes have you done in the past with your dogs? Were they helpful? Will you do it again?
34. What will you do if your new Golden chews your belongings or exhibits other destructive behavior?
35. What issues are you willing to work on with your new Golden? That is, what issues are you willing to accept until you can correct them through training?
36. What behaviors are unacceptable to you? That is, what behaviors would you not be able to live with? What steps would you take to correct these behaviors?
37. Excluding your death, what conditions or circumstances would cause you to give up an animal?
38. Would you consider fostering a Golden, possibly in addition to adopting?
39. Would you consider adopting a bonded pair?
40. Would you consider adopting a special needs Golden?
41. How did you hear about SCGRR?
42. Questions or Comments?
I attest all information I provided above is true. I promise to care for a Golden Retriever to the best of my ability, with the full intent of keeping the dog for the duration of its life. I also agree to keep a collar with tags on the dog, provide quality dog food, adequate shelter, veterinary care and training as needed.
Online Signature:
Please click on the SAVE button (JUST ONCE) to submit your application to SCGRRescue. Thank you!