NCGDRNE Adoption Application

Date of Submission Put in the date you filled out the application
Please list the name of the Great Dane(s) you are interested in adopting
Are you interested in Male or Female dog? No Preference?
Are you interested in an older dane? younger dane? age doesnt matter?
Applicant's First Name *
Applicant's Last Name *
Street Address *
City *
State *
Apartment Number (if applicable)
Zip Code *
Phone Number * Please use the following format 248-555-1212
Email Address * Please double check your entry as this is the main way we will contact you
Have you applied anywhere else for a pet?	NoYes
If yes, where else have you applied for a pet?
Is this pet for you or someone else?	Myself Someone else
If someone else, please elaborate and tell us who and why
How did you find out about us? How did you find out about us and the mission that we do here at Northern Chapter Great Dane Rescue of New England	Petfinder Internet Search Family/Friend Staff/Volunteer Instagram Facebook/TikTok Twitter Other
What is your Employment Status? *	Full-Time Part-Time Retired Work from Home Stay at Home Parent Student Unemployed Other
If you chose "other" above, please explain:
If you are employed, what is your current occupation? *
Current Employer Name *
How many hours worked per week? *
Are there any family members that are home during the day? *	NoYes
If No, on average how many hours per day will your Great Dane be left alone? *
Do you have stable housing?	Own Rent Someone else owns the Home Someone else rents the Home
Please select your current residence type.	House Apartment Condo Townhouse Mobile Home Other
Do you have a completely fenced-in yard? If so, what kind of fence?	Wood Chain Link Electric Plastic Iron Other Other (I do not have a fenced yard)
If you do not have a fenced yard, how will you let the animal out?
If you answered "other" above, please explain:
How long have you lived at this address?	Less than one month 1-2 months 3-6 months 6-9 months 9-12 months 1-2 years 3-5 years 6-10 years 10 + years
If you rent, does your landlord and lease allow pets?	Yes No Unsure N/A
Landlord's Name
Landlord's Number
Including yourself, how many adults live in your household? * Adults are anyone who is 18+
Do you have any children, including any who visit on a regular/frequent basis? *
Please list the ages & relationship of those who live in your home. * Please list any adults age and gender, as well as any child's age and gender, some animals have preferences on who they get along with.
Does anyone in your household have allergies to dogs/cats?	Yes No Possibly N/A
Elaborate on Allergies if needed
Are other members of your household enthusiastic about adopting a Dane?	Yes No N/A
Who will be primarily responsible for the care of this dog?
What is your family dynamic?
Please describe your work and home life balance and how that impacts your animals
Have you ever had to surrender a pet?	NoYes
Elaborate
Have you ever had to perform a Humane Euthanasia on a pet?	NoYes
Elaborate
Have you ever had to perform a Behavioral Euthanasia in a pet?	NoYes
Elaborate
Do you own other pets at the current time? *	NoYes
If yes, please list Please include, type of pet, gender of pet
Are your pets current on their vaccinations?	Yes no n/a
If no, please explain?
Are all of your pets spayed/neutered/fixed?	Yes No N/A
How do you feel about having pets spayed/neutered?	Agree Disagree Not Sure
If you have pets, will they adjust to a new pet in the house?	Yes No Unsure N/A
What Pets have you had in the past 5-10 years? Please include, type of pet, age of pet when passed, reason of passing, gender of pet and if it was altered or not
Veterinarian's Name * Please contact your vet and allow permission for Northern Chapter Great Dane Rescue of New England to talk to them for a reference check. If you have never owned a pet please tell us where you would go.
Veterinarian's Phone Number *
Veterinarian's Address, City, State, and Zip Code * Again if you have never owned a pet please list where you would go
Are you familiar with heartworm and heartworm prevention?	NoYes
Will you keep the animal up-to-date on vaccinations and heartworm preventative?	NoYes
If no, please explain:
How much do you think the annual medical bills will be for your Great Dane?	About $100 $100 - $200 $200 - $300 $300 - $500 $500 +
Are you aware of, and prepared for, the financial responsibility of having a "Giant" Breed. The weekly dog food purchases, the cost of licensing, routine vet care and the occasional bigger purchase of medicine or a surgery
Could you afford an emergency? If a large medical cost were to come up - would you be able to handle a multi-thousand-dollar surgery on short notice?	Yes No N/A
Are you familiar with the health problems associated with Great Danes? Short Life Span, Bloat/Gastric Torsion, Hip/Elbow Dysplasia
Please check the main reason you plan to adopt a pet:	Companion Family Pet Child's Pet Guard Dog Companion for another pet Other
Why do you want to have a Great Dane join your family?
Why did you decide to adopt rather than purchase a puppy?
Have you had Great Danes in the past?	NoYes
Elaborate	NoYes
Where will the animal sleep?	In bed with me In bed with my child In a dog / cat bed In a kennel / crate Wherever he or she likes Outside Other
If you answered "other" above, please explain:
Will this pet be predominantly living inside, outside, or both?	Inside Outside Both
If outside, when will they be outside and where??
If inside, when will they be inside and where?
Will the animal spend any time in the garage?	Yes No N/A
If the animal will spend time in the garage, please explain when/why:
Do you have a pool?	NoYes
Is there a fence around the pool?	N/A Yes No
What kind of fence do you have around your pool?	N/A Wood Chain Link Plastic Iron Other
If you answered "other" above, please explain:
Where will the Dane eat?
How many meals per day will your Dane be fed regulary?
How will you handle accidents in the house and housebreaking?
How will you handle destructive behavior, counter surfing and other things that come with the height and size of this breed?
Are you willing and able to exercise the dog on a regular basis?	Yes No N/A
If yes, what is the method of exercise?	Walking Running Dog Park / Dog Run Other
If you answered "other" above, please explain:
What type of vehicle do you own and the Dane would utilize to get to and from places?	Sedan Crossover SUV Hatchback Coupe PickupTruck Minivan Convertible Luxury Car Sports Car
If you answered "Pickup Truck" will you allow your pets to ride in the truck bed?
What arrangements will you make for the care of your pets in case of an emergency?	Leave with family/friend Boarding Pet Sitter Take with me/us Other
If you answered "other" above, please explain:
What will you do with the animal when you go on vacation?	Leave with family/friend Boarding Pet sitter Take with me/us Other
If you answered "other" above, please explain:
What would you do with your animal if you had to move?	Take him / her with me Give to family or friend Return to shelter Other
If you answered "other" above, please explain:
Are you willing to take responsibility for this animal for the next 10-20 years?	NoYes
If no, please explain:
Will you allow us to perform home checks?	NoYes
I understand that there is a requested donation adoption fee of somewhere between $250 and $400, depending on our budget * Please Initial
I/We (nor any member of Adopter's household) have never been charged with abuse or neglect to animals or children * Please Initial
If there is a change of address, phone, etc., during the life span of the rescue dog, the adopter agrees to inform NCGDRNE within 14 business days of the change * Please Initial
The adoption family agrees to provide adequate shelter, food, all necessary medical and grooming care for the life of the Dane. If the dog is to be euthanized, you will contact NCGDRNE * Please Initial
The dog shall never be subjected to any form of cosmetic/option surgery or alteration including, but not limited to, ear cropping, tail d ocking, etc., unless medically necessary * Please Initial
The dog shall not be abused in any manner. The dog shall not be trained or used for attack, protection or guarding of property, and will never be used in any aspect of dog/animal fighting. The dog will not be the subject of, not subjected to any biological, chemical, psychological, or other experiments. * Please Initial
The dog must be licensed in accordance with existing laws in your town and rabies vaccine must be kept current and wear a collar with the license tag on it at all times when outside the home. You must agree to follow a regular inoculation program as established by your veterinarian and state law * Please Initial
If for any reason the adoption is not found to be satisfactory, Adopting Person(s) agrees to notify NCGDRNE immediately to arrange for his/her return to us * Please Initial
The rescue dog must not be sold, given or released to any party other than NCGDRNE * Please Initial
NCGDRNE reserves the right to a home visit without notification and to get veterinarian records on said dog at any time. A home visit will be arranged for a time period after the day of adoption * Please Initial
Everything we know about the dog you are adopting has been told to you. Any behaviors in the home are as new to us as they are to you. Because we get very little in details about the dog, we test for behaviors but foster life, and more off kennel life is very different than a home life so you may see things that the dog did not present while in our care. *
I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. I am authorizing you to contact landlords, associations and veterinarians. You are also aware that we cannot guarantee the health and temperament of the animal. Please remember, that this Great Dane may be confused when you first work with him/her, but with patience, consistency, and reassurance, he/she should readily adapt to the routine of the home. I, the Adopter, understand that NCGDRNE is whom I am signing this contract with. I, the Adopter, hereby acknowledge that I have read this entire Agreement and understand its terms and conditions and agree to be bound by same.	Clear
Date of Birth
Drivers License Number
Personal Reference #1 *
Personal Reference #2 *
Please contact your Veterinarian and provide them permission to speak with us. Sign that you understand *	Clear
Picture of BackYard
Picture of FrontYard
Picture of Kitchen
Picture of Living Space *
Picture of the Entrance to the Home *
Picture of the Dog Living Space *
Picture of Dog Eating Area *
Picture of the bathroom

44 Mill Street, Jeffersonville VT 05464 info@gdrnenorth.org 802-324-4586