Golden Retriever Rescue Adoption Questionnaire

Name/s:
Contact number/s:
Street Address:
Suburb & POSTCODE:
State (VIC, ACT, NSW):
Email address:
Please be advised that these details will be given to a representative of GRR who will
contact you to make arrangements for a convenient time to conduct a premises inspection.
GRR rehome throughout NSW, ACT and VIC. Due to lack of resources to maintain our
rehoming procedures, it is difficult to rehome in other states, but GRR will retain on
file approved questionnaires from other states and contact these families when GRR
receives alerts on Golden Retrievers requiring homes in other states of Australia.
1. The approximate age range (YEARS or
MONTHS) of the Golden Retriever you would
like to adopt. Give minimum maximum age.
2. Would you prefer a male or female Golden
Retriever

Male

Female

Either

3. Why have you chosen the Golden Retriever

breed to adopt?

4. Do you have children living in the home?

Yes

5. Do you have children making visits to the

home? If yes, are visits daytime only or do
they include overnight stays?

Yes / No
If yes, daytime and/or overnight?

No

6. If you have children or visiting children, how

old are they?
7. Do you have any pets?

Yes

No

Yes

No

Yes

No

8. If you have pets, please list the type/s of

pet/s you have and their age/s.

9. If you have other pets, are they desexed?

10.
Describe your pets behaviour around
other animals.

11.
Is there anyone in the home who is
elderly or has a physical disability which could
be affected by contact with a large dog? If
yes, please describe.
12. Is your home rented?

Note: If your property is rented, we will require a letter from your landlord or managing estate
advising that a large dog is permitted on the premise and that is inclusive of inside the house.

Yes

13. Do you own your own home?

No

Note: GRR requires proof of ownership in the form of a rate notice which can be viewed by a GRR
representative at the time of the premise inspection.

14. Please describe the type (paling,

colourbond, post and rail etc) and MINIMUM
height of fencing and gates on your property
(we require actual measurements please).

Type:
Height:

15. How are the gates secured?

16. Do you have a swimming pool?
If yes, is it fenced off separately from the
rest of your yard, and if so, what is the
height and material of your pool fence?
17. If you have stairs please advise the number
of steps in each staircase both inside and
outside the home.

Internal:
External:

18. Please advise the number of hours PER

WEEK the dog would be home alone (ie
with no people present)
19. Please describe shelter from rain and shade
for the dog while you are away from the
home
20. Would the dog have access to come inside
the house while the family is at home?

Yes

No

27. Would you be prepared to go to obedience

classes to train your dog (not just 'puppy'
classes)?

Yes

No

28. Are you are aware that Golden Retrievers

shed hair and the grooming that is required?

Yes

No

Inspected
by:

Yes /

21. Please advise where your dog will sleep AT

NIGHT? If outside, please describe the
shelter you will provide. If inside, please
describe where in the house its bed will be.
22. Please advise arrangements for holidays if
the dog is not accompanying the family
23. Have you owned a dog previously?
If yes, please advise the breed of dog/s you
have owned

24. Please describe the type of exercise and

activities you intend to do with your dog and
the average hours PER WEEK you will
spend exercising your dog.
25. Do you have access to off-leash areas near
your home?
26. Please advise the age of the person who
will be in control of the dog while out walking

Approved:
No

Date
:

29. Are you aware of the ongoing costs involved

with veterinary care, grooming and food?

Yes

No

30. Do all adults who are resident in the home

know about and support this application to
adopt a GRR rescue goldie?
31. Is there any additional information you feel
is relevant to your application with GRR?

All our rescues come microchipped, desexed, vaccinated, heartworm tested and treated,
treated for intestinal worms and fleas for a rehoming fee of $500.00 and $550.00 for pups
under 12 months. This fee assists our rescue fund. You will receive a tax deductible receipt
as GRR Inc. is a registered animal welfare Charity (CFN 20759).
GRR takes pride in finding not only the best homes for our Goldies but the home which suits
the individual needs of each dog.
When GRR place a Goldie it is forever.
We look forward to hearing from you.
Golden Retriever Rescue Inc.
Please email your completed adoption application to: mail@grr.org.au

Inspected
by:

Approved:
No

Yes /

Date
: