GREAT DANE CLUB OF NEW ENGLAND, INC. RESCUE

ADOPTION APPLICATION

Please return along with a $25 non-refundable fee made payable to:

Great Dane Club of New England, Inc. Rescue

PO Box 1006

Clinton, MA  01510

 Name _______________________________________________________________________

Address ______________________________________________________________________

City _______________________________ State __________ Zip ________________________

Phone Number _______________________ Fax Number _______________________________

What type of home?     Apartment     House     Condo     Mobile Home     Other _____________

Do you      ___Own     ___Rent       ___Live with your parents     ___Other (please explain) ________________

How long have you lived there? _________________

If you are a renter, does your rental agreement permit you to keep large dogs? _________________

(We will need a letter from your landlord verifying this)

Occupation Adoptive Owner______________________________________________________

Occupation Adoptive Co-Owner___________________________________________________

Email _____________________Who referred you to Great Dane rescue? __________________

Have you had a Great Dane before? __________ If yes, how many and where did you get

them? ________________________________________________________________________

What happened to them? ___________________________________________________________

_____________________________________________________________________________

If no, why do you want a Great Dane? ______________________________________________

_____________________________________________________________________________

Have you had other breeds of dogs? If yes, what were they? _____________________________

______________________________________________________________________________

What happened to them? _________________________________________________________

______________________________________________________________________________

Name of your Veterinarian ________________________________________________________

Address _______________________________________________________________________

Telephone ________________________________

Do you have a fenced yard? ________ If yes, what kind of fence and how high is it? ____________

________________________________________________________________________________

Where will you keep your dog when you are at home? __________________________________________

Where will you keep your dog when you are not at home?  _______________________________________

Is there a family member home during the day?  ___________

If no, how many hours a day will your new dog be alone? _______________________

Do you plan to travel with this dog? _____________ If no, where will the dog stay while you are away?

_________________________________________________________________________________

Who are the members in your household?

How many adults? ___________ How many children? ____________Ages of Children________________

Who will be the primary caretaker of this animal? _________________________________________

Do young children visit your home on a regular basis? _____________________________________

Is anyone in your household disabled, handicapped or have special needs that we should be aware of? ___Yes___No

 If yes, please explain____________________________________________________________________________

Does anyone in your household have allergies to animals? __________

If yes, what types ___________________________________________________________________

Are other members of your household enthusiastic about adopting a Dane? _____________________

Do you currently have other pets? Please list them (include type/ages) ______________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

 

Are you familiar with the health problems associated with this breed? _______ (short life span, bloat/gastric torsion)

Are you aware of the cost of food, licensing and regular veterinary care? (one antibiotic treatment can cost as much as $150.00)_____________

Why did you decide to adopt rather than purchase a puppy? _____________________________

______________________________________________________________________________

I would like to have a dog that is:

An adult _____ (1 to 5) ______ mature (over 5)

I prefer: ____ male ____ female ____ no preference. Color preference? _____________

What is the oldest dog you would consider adopting? ___________________________________

Will you agree to spay/neuter? _____

Will you adopt a dog with special health needs? _______________________________________________

May we visit your home and check references to verify the information you have provided?  _______

I understand that Great Dane Club of New England, Inc. Rescue does not warrant the health, temperament or behavior of any dog placed and is not to be held liable for acts of the dog.  I understand that the application fee does not guarantee the placement of a dog in my home. I understand there is no adoption fee, but a tax-deductible donation (typically between $300 and $500) helps defray the cost of the care of this pet and others while in our care. The Great Dane Club of New England, Inc. is a 501(c) 3 charitable organization.  I further understand that if a dog is placed in my home I will be expected to sign an adoption agreement with the Great Dane Club of New England, Inc. Rescue and that it is customary to make an appropriate tax-deductible donation, which can be discussed with the coordinator.

 

Signature ________________________________________ Date ______________________

 

 

 

 

7.25.10