Adoption App

Completion of this application does not guarantee or reserve a dog. SRGDRR INC reserves the right to deny any application for adoption for any reason.

SRGDRR’s mission is to re-home our dogs with loving, caring and responsible people. Therefore, all information will be verified. Incomplete applications will NOT be processed.

Name of Dog

Full Name

First Name Last Name

Spouses Name

E-mail

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number

Cell Number

Driver License / State / Exp Date

Emergency Contact - Someone that does NOT live with you.

Full Name

First Name Last Name

Phone Number

Area Code Phone Number

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Have you ever owned a Great Dane before?

Yes No

What would your preference be in your Great Dane?

No Preference Some Preference

Gender

Male Female

Color

Age

Ears

Cropped Natural No Preference

How many pets do you currently own?

Please tell us type, breed, age, altered, and gender of all your current pets:

Do the animals listed above get along with other dogs?

Yes No

Have you ever had to surrender an animal?

Yes No

If yes, please explain:

Have you ever had to euthanize an animal? If so, please explain:

Have you ever bred a litter of puppies?

Yes No

Have you ever attended obedience classes?

Yes No

What dog food do you feed your dogs? Or what have you used beforehand if you currently do not own a dog anymore?

Veterinarian Information - Please list all veterinarians you use currently and have used in the past.

Full Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number

Full Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number

References - Please list 3 non-family, personal references.

Full Name

First Name Last Name

E-mail

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number

Full Name

First Name Last Name

E-mail

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number

Full Name

First Name Last Name

E-mail

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number

Housing Information

Size of your yard:

Do you have a fence? If so, what type? And what type of gate latch?

Is there shade in this area?

How many hours will the dog be left outside?

How many hours a day will the dog be left alone?

What will you do with your animals if you go on vacation?

Are you aware that boarding is more expensive for a Great Dane?

Yes No

Please tell us all members of the household, including ages. If they have allergies to pet dander, list that as well.

Do you rent or own? Please also tell us who you are renting from and include a copy of authorization stating you can have a Great Dane indoors.

Authorization from landlord:

May a SRGDRR rep visit your home to do a home check?

Yes No

Are you willing to give your dog at least one month to adjust to his/her new environment?

Yes No

Would you consider a second Great Dane in the future?

Yes No

Would you be willing to Transport a Dane in need?

What Areas Would you be willing to do?

Cities or states

How far would you be willing to travel?

Miles

What restrictions would you have?

ie. Size, temperament, health problems?

If a Great Dane is placed with me/us, I/we agree to cooperate with SRGDRR INC in its attempt to provide a smooth transition for dogs and humans alike. I/we also agree to contact SRGDRR INC about problems that might arise in the future. Should the dog need to be removed, or euthanized (prior to normal old age), I/we will contact SRGDRR INC prior to taking any action to determine whether the dog might be a candidate for placement elsewhere. I/we certify that the information provided is true, correct, and complete to the best of my information and belief and that I have not willfully concealed any information in answering the above questions.

SRGDRR makes no warranty as to temperament or physical condition of the rescue dog. The rescue dog is being adopted as is. All rescue dogs are advertised by information supplied from previous owners, shelters, and other forms. SRGDRR does not guarantee any DNA genetic makeup of any rescue dog and cannot be held liable for rescue dog not being pure or a certain mix. There is no refund. DNA testing can be offered at the prepayment fee provided by adopter. It is not included in the adopt fee donation.

Full Name

First Name Last Name

This is for your E-signature:

Month Day Year

Signature *

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My Products *

Application fee $ 20.00

Total $ 0.00

Adoption Application

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