GOTGM Adoption Application

Guardians of the Green Mile Inc.
Adoption/Foster Application-Thank you for your interest in adopting a pet from Guardians of the Green Mile Inc. We are a group of individuals who have come together to save the lives of animals in danger of being euthanized.

All of the dogs in our Rescue are in Foster homes while they are looking for their forever family. Meet and Greets will be set up after your application is in process.

We appreciate your taking the time to fill out the application to adopt one of our Guardians of the Green Mile pets. The questions we ask are only to find the right fit for all our dogs and the families that will adopt them. Please complete the form to the best of your ability. Enter N/A if a question does not apply to you.

Adoption fees are $300 for dogs that are one year and older. $350 for puppies under one year. A $50.00 Deposit will be refunded after the Puppy is Spayed or Neutered.

Included in the adoption fee: All animals will be fully vetted, microchipped, and spayed or neutered.

Renters must submit a copy of their lease agreement to verify the Landlord.- We will not proceed without it.

We require that all Fosters and Adopters with personal animals be spayed/neutered. Age appropriate and healthy enough for surgery, We will verify that with the reference call to your Veterinarian.

We are 100% volunteer operated and will process your application within a few days to a week, depending on volunteer availability. We will be checking with your veterinarian and personal references. Please let them know ahead of time. Applicants will be interviewed and require a home visit before being approved to adopt or foster a dog from GOTGM.

Applicants must be 21 or older.

Thank you, Guardians of the Green Mile.
Are you interested in adopting or fostering a dog?*

AdoptFoster
Dog Information
Name of the dog you are applying to adopt*
Enter ANY if not specific
Breed*
What characteristics about this dog are most interesting to you?*
Why do you want to adopt a dog?*
How Did You Hear About GOTGM?*
Have you ever Applied to Adopt or Foster with GOTGM before?*

Yes AdoptedYes FosteredNo
If the answer is Yes to Foster or Adopt. What was the name of the dog*
Applicant Information
Full Legal Name*

First NameLast Name
Date of Birth*

MonthDayYear
Driver's License Number and Issuing State
E-mail*
Are you a Veteran? We partner with groups that may be able to help with adoption and training costs*

YesNo
Primary Phone Number*
Cell Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer *

Employer Name

Street Address

CityState / Province

Postal / Zip Code
Work Phone Number*
How long have you worked there?*
Co-Applicant (Spouse or Significant Other) Information
Co-Applicant Full Legal Name*

First NameLast Name
Co-Applicant Date of Birth*

MonthDayYear
Co-Applicant Driver's License Number and Issuing State*
Co-Applicant E-mail*
Co-Applicant Primary Phone Number*
Co-Applicant Cell Phone Number*
Co-Applicant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Co-Applicant Employer*

Employer Name

Street Address

CityState / Province

Postal / Zip Code
Co-Applicant Employer Phone Number*
How long have they worked there?*
Household Information
Type of residence:*

Single Family HouseApartmentCondo/TownhouseMobile Home
Do you:*

OwnRent
If renting, provide landlord's name & phone number.
A copy of your lease to cofirm landlord and pet policies will need to be presented
How long at present address?*
Please list name, age and relationship of each person living in household, including yourself:*
Is anyone allergic to animals?*

YesNo
Will the dog be included in family activities?*

YesNo
How active is your family*

very activesomewhat activenot very activecouch potatoes
Is everyone in agreement to adopting?*

YesNo
Have you ever adopted from a rescue/shelter/animal control agency?*

YesNo
If so, who did you adopt from?
Do you have plans to move in the near future?*

YesNo
If you did move, what would you do with your animals?*
How big is your yard?*
Is your yard fenced?*

YesNo
Type of fencing?*

ChainVinylWoodIn-ground ElectricOther
How tall is fence?*

4 feet6 feetOthernone
Do you have a pool?*

YesNo
Is there a limit to the number of dogs you can have where you live or do you have any BSL Laws in your area ?*

YesNo
If yes, what is it?
Please describe the neighborhood you live in. Ex: town or country, quiet or busy, major roads; traffic, are there a lot of children, dogs etc...*
Many animals are surrendered to shelters due to family issues; we are sorry to have to ask this question. Are there any relationship issues that would be affected in a negative way by bringing a new pet into the home?*
Have you or anyone in your household ever been convicted of a crime against animals (neglect, abuse, etc)?*

YesNo
Current and Past Pets
Please list all animals you currently own by breed/sex/gender and a short description of any current dogs personality & temperment
Dog #1
Dog #2
Dog #3
Other Pets
Do you have*

chickenslivestockany other animalsnone
Do you have cats?*

YesNo
If yes, do they stay

indoorsoutdoorsboth
Are all of your pets current on vaccinations?*

yesno
If no, please explain why
Are all of your pets spayed & neutured? GOTGM requires all animals be spayed or neutered age appropriate unless deemed unsafe to do so by your care giver. *

yesnoMedical reason why surgery can not be preformedNot old enough for spay or neuter
Are you able to afford unexpected medical bills for a dog?*

yesno
If no, please explain why
How many pets have you owned in the last ten years?*
Where are those pets now? Please list them.*
Have you ever had to surrender a pet to a shelter or euthanize a pet?*

yesno
If yes, please explain circumstances
N/A if no
If you have other pets, how do you plan to help them adjust to a new pet entering the household?*
New Pet Information
These are rescue pets and may or may have not been exposed to a home environment. Everything will be new and a lot of training may be required. This pet will not be the perfect pet that knows what you want of him/her. It will take time and patience on your part.
Please mark the characteristics that are most important to you (Check all that apply)*

Kid FriendlyDog FriendlyCat FriendlySmall DogMedium DogLarge DogExtra Large DogCuddlerLonerMostly QuietSleeps in Bed with YouSleeps in Own Bed/CrateShyOutgoingPotty TrainedCrate TrainedLeash Trained< 1 Year Old1 to 3 Years Old4 to 7 Years Old8 Plus Years OldNon-SheddingShort Hair Low GroomingRegular Grooming (Long Hair)
Who would be responsible for the dogs daily care?*
Where will the dog sleep at night?*
What will be your newly adopted dogs living situation? (Check all that apply)*

Indoors (except for potty)Indoors/OutdoorsGarage/BasementOutdoors OnlyOutdoors with Cover
How many hours a day would the dog be left alone?*
When home alone, where would your newly adopted dog stay? (Check all that apply)*

Loose IndoorsConfined to One RoomCrated IndoorsCrated OutdoorsFenced YardLoose No FenceChained Outside
How will you exercise your dog? (Check all that apply)*

Leash Walks DailyIn Outdoor Kennel/RunFree Run of Fenced YardFree Run of Unfenced Yard
Will the dog be tethered?*

YesNo
If yes, when?
Do you plan on taking this dog to training classes?*

YesNo
Do you have experience with health/behavior issues? Please explain.*
Are you willing to adopt a dog with behavioral issues?*

YesNoMaybe
What are unacceptable behaviors?*
What would you do to correct the above behavior? (Check all that apply)*

TrainingContact GOTGMPrivate TrainingGive Away
Are you physically and financially able to care for this dog?*

YesNo
Are you willing to adopt a dog with minor medical issues?*

YesNoMaybe
How much are you willing to spend on vet bills and what would you do if the vet bills go over this amount?*
Will you keep this dog up to date on vaccines, heartworm and flea and tick prevention?*

YesNo
What type of food will you feed this dog?*
If your new dog is not housebroken, how will you train it?*
Where will the dog stay during family trips/vacations?*
What provisions will you make for the dog should you become unable to care for it?*
What would you do if you could not keep the dog?*
Are you getting this dog on behalf of another person or as a gift?*

YesNo
If yes, please explain
Are you willing to commit the time and effort to acclimate this dog to the new surroundings of your home and schedule?*

YesNo
Are you committed to giving this dog a FOREVER home and having the dog stay with you for the remainder of its life even if your circumstances change (i.e. children, moving, etc.)*

YesNo
Veterinary Information
Please contact your vet and give them permission to speak with someone from Guardians of the Green Mile. Many Vet's offices must follow the same privacy laws as our own human doctors. It is necessary for you to contact your vet with a verbal release and let them know that we will be calling them for information regarding your past and current pets(s). Depending upon their requirements, you may also need to sign a written release of information form. If we are unable to verify your vet information, we will not process your application.
Vet Clinic*
Vet Name*
Vet Phone Number*
Vet E-mail
Name your current pets are listed under*
Groomer Reference
Many of our dogs require regular grooming. Please provide your groomer reference if you have or have had a breed that requires grooming.
Groomer/Salon*
Groomer Phone*
Personal References - must not be related to you.
Please provide us with three (3) personal references for you and your family that are NOT related to you, that do NOT live with you and they can NOT live in the same household as each other. Please let your references know that we will be contacting them and that they are authorized to communicate with us regarding your application. We will contact all three references and must talk with them in order to approve your application.
Reference #1 Name*
Reference #1 Phone*
Reference #1 Relationship*
Reference #2 Name*
Reference #2 Phone*
Reference #2 Relationship*
Reference #3 Name*
Reference #3 Phone*
Reference #3 Relationship*
Will you allow GOTGM to do a home visit prior to and after adoption?*

yesno
Any other comments or information you would like us to know in considering your adoption application? We want to make sure that we help you find the best match for your family.
***Please note, we MAY require a $50 deposit to hold your puppy/dog once your application is approved and your home check is complete. The deposit will be applied to your pet's adoption fee. This will allow us to hold the pet for you and your family. Refunds will be given up to one week after application is signed should you change your mind. A written request for refund is required in order to cancel the adoption on your pet and refund adoption fee.
I hereby authorize the release to GOTGM Inc my entire vet records for any and all animals that I have or have had. I authorize GOTGM Inc. to conduct a rental and personal reference check, employment reference check and authorize the release of this information.
By submitting this form, I hereby certify that all information provided by me is true and complete. This application is not a binding agreement. Applicant is under no obligation to adopt a dog and Guardians of the Green Mile Inc. is under no obligation to provide a dog to the applicant. Dogs suggested to the applicant based on this application and the subsequent interview and home check may differ from dog(s) listed on this application as Guardians of the Green Mile Inc. may believe that different dogs are a better match for said applicant. All applications are subject to acceptance based on a review process that requires collecting information from references and visiting the applicant's home. All decisions on placing dogs in adoptive and foster homes are based solely on the judgement of the volunteers and board of directors of Guardians of the Green Mile Inc. Applications submitted through this form may be denied for various reasons. Guardians of the Green Mile Inc. reserves the right to make all decisions regarding placement or final disposition of any rescued dog in its care whether in, or being placed in, a foster or adoptive home or other facility. By submitting your completed application to Guardians of the Green Mile Inc., you attest that you have read the above disclaimer and agree to the terms therein. Futhermore you represent that the information you have provided on this form is the truth and to the best of your knowledge and belief. I hereby forever release, discharge and agree to hold harmless and indemnify Guardians of the Green Mile Inc., it's board of directors, and its members, officers and agents from all claims, demands, actions, causes of action or liability of any kind whatsoever arising as a result of or in connection with the fostering or adoption of a dog sponsored by this organization.
E-Signature*
TYPE Name
Co-Applicant E-Signature*
TYPE Name
Date

MonthDayYear
Enter the message as it's shown*
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Landlord permissionVet ReferencePersonal ReferencesEmploymentApproved
GOTGM Adoption Counselor
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