NORCAL Golden Retriever Rescue

Please note that NGRR is chartered to operate in Northern California from San Luis Obispo and Fresno counties to the Oregon Border and the Reno/Lake Tahoe area of Nevada. If you are within this area, please select the County/City pair closest to you from the dropdown below (this is a required field).

You must complete your application once you begin. If you leave the questionnaire and return later, you will have to start over.

If your county is not listed (meaning you are outside our chartered area), we suggest that you instead contact your local state rescue group which can be found at: www.grca-nrc.org

Originating Area

Personal Information

First Name

Last Name

Phone: (h)

Phone: (w)

Phone: (c)

Address

City

State

Zip

Basic Dog Information:

Dog Name

Age

Approxmate Weight

Color and any markings

AKC number

Gender

Male Female

Breed

Neutered / Spayed

Microchip Number

Manufacturer Microchip Maker

Dog History:

How long have you had the dog? (in years)

Where did you get the dog?

How many owners has the dog had?

Has the dog ever been boarded?

Yes No

Why?

Why are you giving up the dog for adoption?

How soon do you need to find another home for your Golden?

Medical / Physical History:

Describe any allergies, other medical conditions or physical disabilities.

Has the dog ever had seizures?

Yes No

Describe, severity, frequency etc.

When was the dog last at the vet for shots?

Current medications if any.

Vet's name/Clinic name

City

Vet's Phone

Describe special diet if any

Living Conditions

Tell us where the dog spent most of the day: indoors or outdoors, garage?

Where did the dog sleep at night?

How long was the dog left alone during the day?

How often the dog was regularly exercised?

Describe exercise activity and frequency.

How was the dog confined to the property?

How often, if at all, did the dog escape confinement?

Describe any escape issues

Children, Pets, Cars

Describe other dogs in the household, if any, and how this dog got along.

Describe other cats in the household , if any, and how this dog geo along.

How many children and their ages were in the household.

Describe any problems between the dog and the children, if any

Does the dog enjoy riding in cars?

Behavior / Training

Tell us if the dog house broken and can dog obey minimal commands such as sit, stay, down.

Describe any obedience training that dog has had.

Tell us abut the dog’s energy level: e.g., very active, requires constant attention, very mellow, etc.

Describe any observed any behavior or obedience problems such as failure to come when called, refusal to sit or lie down when told, counter surfing, scratching the furniture, jumping on the furniture, etc. ?

Describe any barking more than when people come to the door, when small animals come into the yard, etc.; and if this created a problem with neighbors.

Describes dogs reaction to loud noises like thunder.

Describe any digging issues.

Describe any other behavior traits (drooling, humping; chasing the tail, etc).

Describe if your dog pulls on the leash when out for a walk, and what you do about it.

Describe any other behavior or training issues.

Aggression Issues

Many dogs growl: as a warning when someone approaches their house, to other dogs when they get too close, older dogs to puppies, etc. This is not aggression but normal dog behavior. We are more concerned with biting, especially with little cause. Biting a family member is a very serious issue. Many dogs may occasionally snap at other dogs (without actually biting) to demonstrate territory; protect the family from others getting too close, etc. This is also not a serious aggression issue unless the dog snaps when not justified and lands a real bite.

Describe any fear (cowering) or aggression (snarling, biting) towards men, people in uniform, other dogs, etc?

Describe the kind of incidents where the dog snapped at, or but didn’t land his teeth on another dog or person. Be especially clear on whether the dog was provoked, teased, etc.

Describe all incident s where the dog has bitten any family member. Be especially clear on whether the dog was provoked, teased, etc.

Describe if any biting incident resulted in medical attention.

Describe if the dog has to be muzzled at any time including while at the vet?

If your dog has ever exhibited aggressive behavior, please describe what you did about it: training, behaviorist, etc.

Possession Issues

Describe if your dog has any food possession issues such as pushing the dish away from you, or growling if you come near the food bowl?

Does the dog have toy aggression issues such as pulling away from you, clamping down hard, or growling if you try to take a toy away?

Surrender Reason

NGRR publishes a semi annual Newsletter that we mail to our NGRR friends that is filled with wonderful stories about successful adoptions and our events during the year. May we add you to the Newsletter Mailing List?

Email Only Mail Only Email & Mail

Video

Video by Paul Bliss - www.blinc.net, music by Suzanne Ciani - www.sevwave.com

Surrender Form