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Adoption Application


There is a $30 Non-refundable Application Fee. You may pay by check or PayPal/Credit Card.

If paying by check, please enter your Check Number and Date of Check in the Application Fee box listed below. If paying with PayPal /Credit Card, please enter Online Payment in the Application Fee box.

Check mailing instructions and PayPal/Credit Card options will be presented after you submit your form.

* required information

*Application Fee:

A value is required.

Application does not guarantee adoption of a dog from TGRR. Your application will be reviewed once the fee has been received and you should be contacted within 2 weeks after the check clears.

Applicant 1

*First Name: A value is required.
*Last Name:
A value is required.
*Email: A value is required.Invalid format.
*Home Phone: A value is required.
Mobile Phone:
Work Phone:

Applicant 2

First Name:
Last Name:
Mobile Phone:
Work Phone:

Home Address

*Address 1 A value is required.
Address 2
*City A value is required.
*State Please select an item.
*Zip Code:
A value is required.

Dog Preferences

*Gender: Male   Female    No Preference Please make a selection.
*What age range Golden do you prefer? A value is required.
*Would you consider adopting a senior or special needs Golden? Yes   No Please make a selection.
Additional Preferences:
Reasons for wanting a Golden Retriever:

Family Structure and Lifestyle

*Do you own or rent? Rent   Own Please make a selection.
*Do you live in a house, townhouse, or apartment? House   Townhouse   Apartment Please make a selection.
If you rent, do you have your landlord's permission to own a dog? Yes   No

Fence Information

*Do you have a fence? Yes   No Please make a selection.
If Yes, is the fence attached to your home? Yes   No
What type of fence is it?
What is the height of the fence?
Is it secure? Yes   No

Family Life

*Where will the dog stay during the day? A value is required.
*Where will the dog sleep? A value is required.
*Where will the dog exercise? A value is required.
*Do you have children at home? Yes   No Please make a selection.
Ages of children
Are they comfortable with large dogs?
Who will be responsible for taking care of this dog?
*How many hours would your dog be alone on an average day? A value is required.
Does anyone in your family have a problem with allergies or dog hair?

Other Pet Experiences

*Have you owned a pet before? Yes   No Please make a selection.
What kind?
What happened to it/them?
Was your previous dog an inside pet or an outside pet? Inside   Outside
*What other pets do have you have now? A value is required.
If your pets are dogs, what is the gender?
Have they ever played with or been exposed to other dogs (socialized)? Yes   No
What were their reactions?
*How do you or would you discipline your dog? A value is required.
*Have you ever obedience trained a dog? Yes   No Please make a selection.
Would you let the dog off the leash outside of a fenced area? Yes   No
*Where will dog stay when you go on vacation? A value is required.
*Who is your regular vet? A value is required.
Please provide your vet's phone number
*Are you ready and willing to take responsibility for a dog, including annual vet checks, vaccinations, boarding, medical care, food? Yes   No Please make a selection.
Have you sold, given away, or surrendered a pet to a shelter, rescue group, or the Humane Society? Yes   No
If Yes, please explain:
*Have you applied to any other Golden Retriever Rescue groups? Yes   No Please make a selection.
If Yes, please specify the group(s) so that we do not duplicate their efforts:

Please add any additional information or comments below:

Please contact your current veterinarian and ask that a reference letter be sent to: TGRR, 3230 Homestead Club Drive, Apt. 3111, Winston Salem, NC 27103. Your application will be acknowledged and a phone interview maybe conducted, but your application will be considered incomplete until the required reference letter is received. 

For your records, a copy of this application will be sent to the email address provided for Applicant1