Name    Phone number

Fax Number  

Full Mailing Address(include city and state)

E-mail    Confirm e-mail

Would you be willing to adopt a Dane with any other special needs; i.e. older, needs surgery, needs
medication, is blind, has behavioral problems, etc.?Yes No

Which dog or dogs (if any) of ours are you interested in?

Why do you want a Dane?

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Pet History 
  
If you have previously owned Danes, who did you                List the pets you currently own      
purchase them from and what became of them?                  (include their name, breed/species, and age)     
              

Are they spayed/neutered and if not, why?                                   

What dogs have you owned in the last 10 years. (include name, breed and  what happened to them)


Have you ever attended dog obedience training? Yes No
Are you willing to attend dog obedience training?Yes No
Does your lifestyle allow you to have the time and energy to properly care for a Dane?Yes No
Have you or anyone in your immediate family ever been charged with cruelty to animals or child abuse?YesNo

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Occupation

Your Occupation
Employer name & phone #
Company Address  
How long have you worked there  
What are your work hours
Are any other members of the household employed?YesNo
List their name, occupation, work hours and company they work for:

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Members of the household

List the names of adults living in your household and how they are related to you

If there are children in the house, list their ages & sex

Is anyone in your family home during the day?YesNo

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Housing

Do you own or rent your home?OwnRent
Does your rental agreement permit you to keep pets?YesNo
How long have you lived there?
Landlord's name  
Landlord's phone #
Do you have a fenced in area for your pets?YesNo
Describe the fencing; material, height, area it encloses.
If you have a pool, is it fenced in?YesNo Not Applicable
Where will you keep your pet during the day?
At night?
When your family is away overnight?
When your family is on vacation?
Are you going to be moving in the near future?YesNo
What will you do with your Dane should you have to move?
What are the leash laws in your area?

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Transportation

What kind of vehicle(s) do you drive

Is at least one vehicle large enough to hold a Dane comfortably in the cab?YesNo

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References:

Veterinarian's name Phone #
Are your pets on heartworm preventive?YesNo
What kind? 
How often do you give it?
Date of last vaccinations?

Name and telephone number of 3 individuals (not related) who know/have known you/your other animals:

May we visit your home and check references to verify the information you have provided?YesNo

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I state and affirm that the information provided on this application is truthful and factual to the best of my ability.  Furthermore, I understand that completing this application does not guarantee me an adoption of a Great Dane and that WSGDRA and/or its members can refuse and deny this application for any reason. I understand the WSGDRA will forward this application to whichever of its member rescues it believes can best help me find a dog. I further agree to allow representatives of WSGDRA and/or its members to contact the references and veterinarian stated on this application.  I further agree that I will allow representatives of WSGDRA and/or its members to visit my primary residence for the sole purpose of performing a pre-adoptive home check.

Signature of Applicant Date
If this from is emailed, typing in your name is treated as a signature

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