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Heartland Great Dane Rescue, Inc.
5525 Hwy 105
Guthrie, OK 73044 (405)260-0026
4. Enclose $10 Check or Money Order made out to Heartland Great Dane Rescue, Inc. for Application Fee.
HEARTLAND GREAT DANE RESCUE
ADOPTION APPLICATION
PLEASE INITIAL EACH OF THE FOLLOWING TO SIGNIFY THAT YOU HAVE READ AND UNDERSTAND EACH STEP IN THE APPLICATION/ADOPTION PROCESS:
_____1) Complete the application form and mail, to HGDR along with a $10 non-refundable processing fee. Be honest and feel free to include supplemental explanatory information. Information on this form will be verified.
NOTE: Please be COMPLETELY honest on this application. The attempt to “look good on paper” will only result in placement of a less than suitable dog with your family.
_____2) A home inspection will be scheduled. If there is not a volunteer available in your area to complete a home inspection, you may be asked to find a suitable person (such as a vet or other Giant Breed rescue volunteer) to complete your home visit. Any fees or donations requested from outside individuals will be solely your responsibility. It is STRONGLY recommended that a donation be made to any other rescue that assists you in this process.
_____3) Wait for a phone call or email of approval. Applications can be denied for ANY reason.
_____4) You will be guided by a HGDR representative in your selection of Danes. We make every effort to place a dog with you that suits your lifestyle and your expectations.
_____5) If there are currently no suitable Danes for you, please be patient. You should feel free to email once a week to check in with us. If you have small children you must be aware that we do not adopt out to families with children under 5. Keep in mind that the more non-negotiable preferences you list (age, color, etc.), the fewer number of dogs will be available to you. Please be patient. Once you are approved, the right dog for you WILL come along, but it may take awhile. Please visit the website often, as the selection of Danes is continuously changing. Though we may contact you if a dog meeting your needs is located, we do not guarantee that this will happen. It will be solely the adopter’s responsibility to stay current with the selection of dogs available.
_____6) Appointments will be scheduled for you to meet the Danes that HGDR has determined would be appropriate for your home. You will not be allowed to take the dog home that day, even if you are sure that it is the one for you. Two things will happen in the next day or so. First, you must take 24 hours, minimum, to give careful thought to this long-term commitment. Second, the foster home and the HGDR representative will discuss any concerns or issues that may have been indicated by the dog’s behavior during your visit. Please note: It is required that all individuals living in the home (including minor children) be present while meeting dogs.
_____7) If a match is made, you will set up another appointment to sign the adoption contract and pay the adoption fee. Now you get to take your dog home. Please note: ALL adults living in the household will be required to be present at contract signing.
_____8) This is not the end of the process. HGDR will follow up on the placement and maintain an ongoing interest for the lifetime of the dog. This may include home visits, which you will agree to in your contract. HGDR will always be available to help you through any issues that come up. Do expect an adjustment period for you, your family, and your dog. Most dogs will not immediately be comfortable, well behaved and housebroken, nor will they immediately befriend your current animals. It takes love, commitment, and patience. It is well worth it in the end.
ALL potential adopters are screened for suitable placements of animals. Heartland Great Dane Rescue, Inc. may refuse placement of an animal for any reason. By submitting this application, you give permission for HGDR and any appointed representatives to investigate and confirm the information that you provide. All forms become the property of HGDR upon submission.
MINIMUM REQUIREMENTS/QUALIFICATION FOR ADOPTION:
(Please initial each item)
_____*You must be 21 years of age or older, or have a parent or legal guardian co-adopt the dog.
_____*You must have your landlord’s consent and pay a pet deposit if one is required.
_____*Your pets must have current vaccinations, be spayed or neutered and be free from contagious illnesses.
_____*You must be able and willing to spend the time necessary to provide training, medical treatment, proper care, and companionship for the pet.
_____*You must submit a non-refundable $10 application fee.
* If these requirements are not met, please do not submit application.
PERSONAL INFORMATION:
______________________________________________________________________________________
Full Name DOB
______________________________________________________________________________________
DL# (State) Social Security Number
______________________________________________________________________________________
Street Address City State Zip
_(_____)____________________________________(_____)____________________________________
Home Phone Cell Phone
______________________________________________________________________________________
Email Address(s)
(_____)________________________________________________________________________________
Work Phone Employer Name and Address
Spouse’s/ Other Adult’s Information:
(If you have a roommate or other adult in the household, please check HERE __________ and list their information in place of ‘spouse’.)
______________________________________________________________________________________
Spouse Name DOB
______________________________________________________________________________________
Spouse’s DL (State) Spouse’s Social Security Number
______________________________________________________________________________________
Spouse Employer and Address
______________________________________________________________________________________
Spouse’s Work Phone Spouse’s Cell Phone Number
______________________________________________________________________________________
Spouse’s Email Address
HOUSEHOLD INFORMATION:
I live in a: House Apartment Mobile Home Condo Other:_______________________
This pet will be kept: Totally inside Mostly inside Mostly outside Totally outside
Number of Adults in household___________
Number of minor children in household_________Ages______________
Have these children been exposed to Giant Breed dogs before? Yes No
Have any of these children ever been bitten by a dog? Yes No
(If Yes, Please explain the circumstances on the bottom of this form.)
If there are no children in your household, how often will this pet come in contact with children? _______
Do ALL of the adults in the household consent to this adoption? Yes No
Does anyone have concerns about adopting a Dane? ______ Who? _____________ What are the
concerns? _____________________________________________________________________________
Are any adults in the household a student? Yes No Who? ______________________________
Do you or your spouse travel frequently? Yes No Who?______________________________
If yes, how often? _______________________________________
How many weeks were you out of town in the last 12 months? ________________________________
Is this above average, below average, or average time away from home? ___________________________
How long will the dog be left home alone during the day? ________hours ___________days a week
Where will the dog be kept while you are at work or away from home? _____________________________
Where will the dog sleep at night? ___________________________
What will you do when you need to travel? ______________________________________________
What will you do with the Dane if you have to move? __________________________________________
Does anyone living in the house have allergies to dogs or asthma that might make living with a dog difficult? If yes, who? ____________________________________________________________________
Do you have a fenced yard? Yes No Type: wood chain-link other
Height at shortest side? __________ft.
If no fence, how do you intend to allow the dog to relieve him/herself? _____________________________________________________________________________________________________
How long at your current address? _____________________________________
Do you own your home? Yes No Do you plan to move in the next 12 months? Yes No
If yes, where?___________________________________________________________________
If you rent: Does your landlord allow pets? Yes No Is a pet deposit required? Yes No
How much? $___________per pet or per household? Size/Weight Limit? Yes No
Limit:_________________ Can proof of deposit be obtained from your landlord? Yes No
_________________________________________________________________________(____)________
Name of Landlord Phone # (required)
PET OWNERSHIP HISTORY:
Have you ever adopted from a humane group, shelter or a rescue? Yes No
If yes, who did you adopt from? ________________________________________
Date of adoption: ______________________________
Name/Type/Breed/ID Number of Animal Adopted: ____________________________________________
Have you ever given an animal up for adoption or gotten rid of an animal? Yes No
If so, why? ____________________________________________________________________________
Date this animal was removed from your home: ___________________________
What did you do with the animal? __________________________________________________________
Have you ever euthanized an animal for any reason other than a terminal illness or injury? Yes No
If yes, please list animal’s name/type/breed/age/reason for euthanasia:
___________________________________________________________________________________________
Has an animal ever died while unattended but in your home? Yes No
If yes, please explain the circumstances:
____________________________________________________________________________________________
Who are you getting this animal for? Self Family Child As a gift for: ______________________
Do you want this pet to be spayed/neutered? Yes No
Why or Why Not?
______________________________________________________________________________________
Do you plan on enrolling this pet in an obedience class? Yes No
Are you willing to enroll this pet in obedience class if needed or advised? Yes No
Are you willing to hire a private professional dog behaviorist if needed or advised? Yes No
How will you teach housebreaking? _________________________________________________________
If you adopt a puppy or under-socialized dog, how do you plan to socialize the dog with other animals, adults, and children?
______________________________________________________________________________________
Are you willing/able to purchase and use a cage/crate if needed or advised? Yes No
Do you plan to chain the dog in the yard at any time? Yes No
Do you plan to leave the dog in an outdoor kennel at any time? Yes No
Total number of pets currently in household: _______
Name/Type/Breed/Age __________________________________________________________________
________________________________________________
Are all of these pets spayed or neutered? Yes No
Are you willing and able to separate your new pet from your current pets for an extended period of time
if advised? Yes No
If no, please explain:____________________________________________________________________
If your new dog exhibits any form of aggression, fear, or attempts to dominate another animal in your household, how you plan on dealing with the behavior? (This is normal behavior for a dog and does not necessarily mean that the dog you adopted is aggressive, but is usually a common sign of stress and the completely normal attempt to establish pack order.) ________________________________________________________________________________________
Pets NO LONGER owned, but owned within the last five years ______________
What happened to the pets? _______________________________________________________________
Are all the pets in your household current on their shots? Yes No
Are all of your dogs on heartworm preventative? Yes No What type?_____________________
Have any of your household pets been diagnosed with infectious diseases in the last 6 months? Yes No
Do any dogs in your household have, or have tested positive for in the past, the following diseases or conditions:
Heartworms _________Distemper ___________ Parvo________ Bordetella (Kennel Cough) _________
Why would you like to add a Great Dane to your family at this time? _____________________________
_____________________________________________________________________________________
______________________________________________________________________________________
Have you ever owned a Great Dane or Giant Breed (100+ pounds) dog before? Yes No
What qualities are you looking for in the Dane that you would like to adopt? Be specific (very active vs. couch potato, etc.): __________________________________________________________________
______________________________________________________________________________________
What do you expect to be the worst and/or hardest part about adopting a rescued Great Dane, and how do you plan to deal with/address it? __________________________________________________________
______________________________________________________________________________________
Do you realize that Great Danes are BIG? __________ Do you know what bloat is? __________________
Do you know that a Great Danes food and water need to be shoulder level? ______________________
NOTE: Please be as honest and clear in your preferences as possible. Every attempt to match your preferences to a dog will be made. Any attempts to “look good on paper” will only result in a less than suitable companion being placed in your home, which defeats the purpose of these questions. Do not, UNDER ANY CIRCUMSTANCES, state that you are willing to accept a special needs dog, a senior, a mix, or any other preference if you are not in fact willing to do so. These are animals that require special care, special owners, and are at a greater risk of re-surrender back to rescue. You will not be denied for stating that you are unwilling or unable to adopt one of these special needs dogs.
Do you have a color preference? _______________________
Do you have a sex preference? _______________________
Do you have an age preference? ________________________
Do you have an ear preference? __________________________
Please list the following items in order of importance to you: age, color, sex, temperament, personality, cropped/uncropped, health, size, other _________________________________________________________________________________________________________
Please list any and all non-negotiable preferences you have (You will only adopt a dog that meets these specific requirements, no exceptions. NOTE: You will not be contacted regarding any dogs that do not meet these requirements, so please only list those preferences that are non-negotiable): ______________________________________________________________________________________________________
Would you be willing to adopt a Dane with one or more of the following special needs? If so, what kind? _____Deaf _____Blind _______Requires additional surgery or medical treatment
_____ Requires ongoing medicines ______Senior (over the age of 5) _______Behavior Problems ______Other: _______________________________________
______I am not willing/able to adopt a Dane with special needs at this time
Would you be willing to adopt a Great Dane mix? Yes No
Do you give permission for an HGDR representative to visit your home prior to adoption to do a home check and after adoption to do follow up checks on your adopted Great Dane for the remainder of their life? Yes No
When are you planning to adopt? __________________________________________________________
How far are you willing to travel to meet an available dog? (Please note, a 24 hour minimum waiting period is required before taking possession of any dog….Please keep this in mind when determining travel distance, as an overnight stay or a return trip may be necessary.) ______________________________________________________________________________________
Are you currently working with another rescue group to adopt a Dane? If so, please list the agency(s) and date of application: (If you apply for or adopt from another agency within six months of your application with us, please advise us of this. This will not necessarily deem you ineligible for adoption, but we must know of any changes in your application.) ________________________________________________________________________________________________________________
Have you applied with another agency in the past 24 months to adopt any breed of dog? If so, please list the agency and date of application: ________________________________________________________________________________________________________________
How have you submitted your non-refundable application fee of $10?
______PayPal (Date:_______________) _____Check (Check # ______)
______Money Order ______ Paid at a Meet and Greet or other event (Date:__________)
I confirm that all the information in this application is correct and complete to the best of my knowledge, and hereby give permission for HGDR to investigate and confirm/verify this information.
Signature _______________________________________________________ Date _________________
Print Name ____________________________________________________________________________
Spouse’s/Other Adult’s Signature_____________________________________ Date _________________
(If Applicable)
Print Name____________________________________________________________________________
___________(Please Initial) I agree to notify HGDR in the case of any changes to residence, phone numbers, employment, family status, pet ownership, or any other pertinent information that may effect the life of the dog or HGDR’s ability to contact me that occur at any time in the six months after date of this application.
___________(Please Initial) I understand that if my application is approved and I meet a dog that I would like to adopt, that I will be required to retrieve the dog within 72 hours of notifying HGDR of my intent to adopt that particular dog. I further understand that if I do not retrieve the dog within 72 hours, the ‘adoption pending’ status will be removed from that dog and other approved applicants will be able to view the dog for possible adoption. (Boarding is available from HGDR on a limited availability basis at the cost of $25 per day once an application is signed and must be paid in advance with the adoption fee. Failure to retrieve the dog within 24 hours of the scheduled pick-up date will result in a refund of adoption fees, but not boarding fees, and the dog will be returned to ‘available for adoption’ status.)
___________(Please Initial) I understand that HGDR cannot guarantee the behavior, temperament, health, parentage, or any other specific of any dog in rescue. Any information that HGDR has regarding each dog will be fully disclosed to me, but I accept the fact that, in most cases, HGDR is not made aware of the background of these animals. I further understand that if I adopt a puppy, it is extremely difficult to determine whether that puppy is a full-blooded Great Dane or not, and HGDR cannot guarantee that the puppy will grow to embody the height, weight, stature, or look of a Great Dane. I will not expect or request that any of my adoption fees will be returned to me, nor will I surrender the dog back to rescue for this reason. I also understand that the stated age of all dogs in rescue is only an estimate, made by volunteers and not experts, and any dog could be significantly older or younger than stated.
IMPORTANT
Veterinarian Information: (this office will be required to provide a medical history on all pets including rabies vaccination certificate – NO EXCEPTIONS)
Name:
Address:
Phone:
How many times have you used this vet?
Names of Animal(s) treated:
Please list additional veterinarians (Name, Address, Phone, Dates of Service, and Animal(s) treated) that you have visited within the last five years:
I, ____________________________, give ________________________________ permission to release
(Applicant’s name) (Name of Veterinary Clinic)
any and all requested documents and information on all pets that are residing in my household or have resided in my household for the last five years from date of this application to a representative of Heartland Great Dane Rescue. This permission expires six months from today, the ______ day of ____________________, 20___.
(If more than one vet has been used in the last five years, please copy this release onto an additional page and fill in the blanks appropriately.)
Personal Reference Information:
Name:
Address:
Phone:
How do you know this person?
Personal Reference #2:
Name
Address:
Phone:
How do you know this person?
Feel free to add any additional comments or information that would be helpful to us in processing this application.
**REMEMBER: APPLICATION SUBMITTED WILL NOT BE VIEWED/CONSIDERED UNTIL $10.00 PROCESSING FEE IS RECEIVED VIA MAIL OR PAYPAL**
Copyright © 2007 HGDR