Return to Adoptable Dogs

Adoption Application

Please print out this form and mail it completed to:
Mary Williams
PO Box 3545
Columbia, SC
Phone: 803-622-1083
Sorry, snail mail only no email.

Name:_______________________________________________Home Phone:_____________

Email address:______________________________________________________________

Address:______________________________________________Work Phone:___________

Applications without home phone numbers will be discarded.

Referred by:________________________________________________________________



My veterinarian is:________________________________________________________



1. Type of Dwelling:      house        condo        apartment        trailer
2. Do you have fencing (yard, kennel)       yes        no
If yes: Type:                                      Length:        Width:        Height:
If no, are you willing to comply with the Rescue's fencing policy?        yes        no        Comments:

3. Why do you want a Golden Retriever?

4. Have you ever owned a dog?

5. Do you have other animals? List type, age, sex:

6. Do you have children? List number and ages:

7. Where will dog be during day?                                                  at night?

8. Are you willing to take the dog to obedience class if necessary?        yes        no

9. Do you prefer a:        male        female        no preference        what age

10. Are you willing to have a member of the Rescue visit your home prior to adoption (by appointment)?

I will be willing to sign an adoption contract in the best interests of the adoptive dog. If you are under 18 years old, you must also have a parent or guardian sign his/her approval.

SIGNATURE                                                                          DATE:
Revised: 01-11