GOTGM Adoption Application

Guardians of the Green Mile Inc.

WE ARE ONLY ACCEPTING APPLICATIONS WITHIN 60 MILES OF PORTAGE INDIANA.

Thank you for your understanding.

Guardians of the Green Mile

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 that have come together to save the lives of animals that are 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 that we ask are to only find the right fit for all of our dogs and the families that will be adopting 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 1 year and older. $350 for puppies under 1 year. PLUS A $50.00 Deposit that will be Refunded after the Puppy is Spayed or Neutered.

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

Renter’s will be required to submit a copy of their lease agreement to verify Landlord .

We require that all Fosters and Adopters that have personal animals must 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? *

Adopt Foster

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 Adopted Yes Fostered No

If the answer is Yes to Foster or Adopt. What was the name of the dog *

Applicant Information

Full Legal Name *

First Name Last Name

Date of Birth *

Month Day Year

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 *

Yes No

Primary Phone Number *

Cell Phone Number *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Employer *

Employer Name

Street Address

City State / Province

Postal / Zip Code Country

Work Phone Number *

How long have you worked there? *

Co-Applicant (Spouse or Significant Other) Information

Co-Applicant Full Legal Name *

First Name Last Name

Co-Applicant Date of Birth *

Month Day Year

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

City State / Province

Postal / Zip Code Country

Co-Applicant Employer *

Employer Name

Street Address

City State / Province

Postal / Zip Code Country

Co-Applicant Employer Phone Number *

How long have they worked there? *

Household Information

Type of residence: *

Single Family House Apartment Condo/Townhouse Mobile Home

Do you: *

Own Rent

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? *

Yes No

Will the dog be included in family activities? *

Yes No

How active is your family *

very active somewhat active not very active couch potatoes

Is everyone in agreement to adopting? *

Yes No

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

Yes No

If so, who did you adopt from?

Do you have plans to move in the near future? *

Yes No

If you did move, what would you do with your animals? *

How big is your yard? *

Is your yard fenced? *

Yes No

Type of fencing? *

Wood Chain Vinyl Other

How tall is fence? *

4 feet 6 feet 8 feet none

Do you have a pool? *

Yes No

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 ? *

Yes No

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)? *

Yes No

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 *

chickens livestock any other animals none

Do you have cats? *

Yes No

If yes, do they stay

indoors outdoors both

Are all of your pets current on vaccinations? *

yes no

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. *

yes no Medical reason why surgery can not be preformed Not old enough for spay or neuter

Are you able to afford unexpected medical bills for a dog? *

yes no

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? *

yes no

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) *

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/Outdoors Garage/Basement Outdoors Only Outdoors 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 Indoors Confined to One Room Crated Indoors Crated Outdoors Fenced Yard Loose No Fence Chained Outside

How will you exercise your dog? (Check all that apply) *

Leash Walks Daily In Outdoor Kennel/Run Free Run of Fenced Yard Free Run of Unfenced Yard

Will the dog be tethered? *

Yes No

If yes, when?

Do you plan on taking this dog to training classes? *

Yes No

Do you have experience with health/behavior issues? Please explain. *

Are you willing to adopt a dog with behavioral issues? *

Yes No Maybe

What are unacceptable behaviors? *

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

Training Contact GOTGM Private Training Give Away

Are you physically and financially able to care for this dog? *

Yes No

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

Yes No Maybe

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? *

Yes No

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? *

Yes No

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? *

Yes No

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.) *

Yes No

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? *

yes no

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

Month Day Year

Enter the message as it's shown *

For Office Use:

Landlord permission Vet Reference Personal References Employment Approved

GOTGM Adoption Counselor