GREAT DANE RESCUE OF NEW ENGLAND
Adoption Questionnaire
Please return with $25 non-refundable fee to:
Great Dane Rescue
P.O. Box 1006
Clinton MA 01510
Name ________________________________________________________________________
Address ______________________________________________________________________
City _______________________________ State __________ Zip _______________________
Phone Number _______________________ Fax Number _______________________________
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 own your home? ______________ 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)
Do you have a fenced yard? ________ If yes, what kind of fence and how high is it? _________
______________________________________________________________________________
Where will you keep your dog during the day? ________________________________________
at night? ______________________________________________________________________
Is there a family member home during the day? __________If no, how many hours a day will the 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 and what are their ages (include yourself) ___________
______________________________________________________________________________
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? _____________________________________________________________________
Does anyone in your household have allergies? _______________________________________
Are other members of your household enthusiastic about adopting a dane? __________________
Who will be primarily responsible for the care of this dog? ______________________________
Do you currently have other pets? Please list them (include 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 Rescue of New England does not warrant the health, temperament or behavior of any dog placed and is not to be held liable for acts of the dog. Great Dane Rescue is primarily a referral service. Final decisions about adoption are made between the parties giving up the dog and the adoptive family. I understand that the fee does not guarantee the placement of a dog in my home. I further understand that if a dog is placed in my home I will be expected to sign a contract with Great Dane Rescue of New England and make an appropriate donation (usually $300.00 to $500.00 depending on age of dog and/or other individual considerations).
Signature ________________________________________ Date ______________________
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