EGRR Dog Listing PayPal Transaction Id Dog's Call Name Owner's First Name Owner's Last Name Street City State WA AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MN MS MO MT NE NV NH NE NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code ** One of three phone numbers is required Phone Day Phone Evening Phone Cell Best time to call Email Best way to contact you Dog's registered name (if applicable) Microchip Type Microchip Number Age Dog's Birth Date Are registered papers available? Registered papers from where? Will you provide these papers to the new owner? How long have you owned this dog? Is dog co-owned? If YES, you must provide a signed release from the co-owner What is dog's sex? What is the dog's color? What is the dog's weight? Is dog spayed/neutered? If not, would be willing to have this done prior to placement? Housebroken? Crate Trained? Was dog bought from a breeder? If from breeder, Breeder's name? Did you sign an agreement to notify the breeder if you couldn't keep the dog? Have you notified the breeder about the need to find a new home? What was breeders response? If you did not buy from a breeder, where did you obtain dog? Please provide details including the name and address if whether private party, pet store or shelter? Vet Name Vet City Vet Phone Are shots up to date? Give date of shots Date of last Vet exam Does dog have any medical or physical problems Allergies On medication (what kind) If unspayed female, when was last heat cycle? If unspayed female, any chance being pregnant? Has dog had any obedience training Obedience training where Any other training? Who was dog's trainer? List commands, tricks and skills What brand food to you feed dog? How much does dog eat daily? Where does dog spend days? Indoors Crated Basement Garage Fenced Yard Loose unfenced Tied out Kennel Run Other Where does dog spend nights? Indoors Crated Basement Garage Fenced Yard Loose unfenced Tied out Kennel Run Other How does dog respond to other dogs? How does dog respond to Cats? How does dog respond to Children? How does dog respond to Livestock? How does dog behave when alone in yard? How does dog behave when alone in house? How does dog behave when alone in car? How does dog behave when walking on lead? How does dog behave when walking off lead? Does dog bark excessively? Does dog dig? Does dog jump/climb fence? Does dog jump on people? Does dog chew destructively? How does dog greet strangers? Has dog lived with children? If so, what ages? Has dog lived peaceable with other dogs? Has dog lived peaceable with cats? Does dog chase other animals? Chase other animals, description Has dog killed another animal? Killed another animal Description? Has dog ever bitten a person? Describe the situation and seriousness of the bite Did wound require medical attention? Was bite reported to city or county animal control? Was dog quarantined? Does dog growl when you take away its food or toys? Does dog snap or nip at people? What causes this behavior? What does dog like best? Dislike? Fear? Why is this dog up for adoption? Have you tried to place this dog yourself? If yes, describe What is the most appealing thing about this dog? What is the dog's biggest fault? Do you understand that any intact dog placed by EGRR must be spayed or neutered as a term of adoption? ** Do you understand that EGRR may not be able to place this dog due to age, health, physical condition, or behavior issues? ** Are you able to keep your dog until he's placed? If not, when do you need him out by? If we take possession of your dog, do you want to be notified if it is determined that he is not placeable? Do you want him returned? How did you hear about EGRR? Please read the following carefully. I hereby make available for adoption through Evergreen Golden Retriever Rescue my dog (named above). I certify that I am the owner of this dog, free and clear of all other interests. I certify that this dog is not possessed of any dangerous or vicious behaviors and that I have not concealed information about this dog that might indicate such behaviors. The information I have provided about this dog is true and complete. I forever release, discharge and agree to hold harmless and indemnify Evergreen Golden Retriever Rescue, its Board of Directors, officers, volunteers 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 adoption or any other disposition of the above-named dog. I agree to provide all pertinent veterinary records and give permission for the release of veterinary records to a representative of the Evergreen Golden Retriever Rescue. I understand that the Evergreen Golden Retriever Rescue cannot guarantee placement of any dog. I understand that once the dog is placed in a foster or adoptive home, I will have no contact with the dog.Read, Understood and agreed: Signature Evergreen Golden Retriever Rescue requires that you certify your application by submitting an electronic signature. To certify your application, please provide an electronic signature (type your name) and click Confirm Signature and Submit. I certify that all the information in my application is accurate and true. Enter Electronic Signature Security code