Adoption Application

Please fill out the form completely. You may enter NA for not applicable if needed. There is a $25 non-refundable Adoption Application Fee. Please use the PayPal Donate button on the top right side of this page to submit the fee. Our volunteers will pair your name on the PayPal transaction with the name on the application to confirm receipt and begin processing your application. If you prefer to submit your application fee via a personal check, submission instructions are at the end of the application form.

Before completing the application, please read the Adoption Process section on this website. Also, please be sure you live in our service area in Southeastern Virginia.

Applicant Information

Applicant's Last Name *

First Name *

Email Address - Please Double Check for Accuracy! *

Street Address *

City *

State *

ZIP Code *

Employer/Occupation *

Age *

Co-Applicant's Last Name

Co-Applicant's First Name

Co-Applicant's Email Address - Please Double Check for Accuracy!

Co-Applicant's Employer/Occupation

Co-Applicant's Age

Relationship to Applicant

Primary Phone *

Primary Phone is a *

Cell phone

Landline

Alternate Phone

Alternate Phone is a

Cell phone

Landline

Best Time to Call *

Preferred Method of Communication *

Phone Call

Text

Living Environment

How long have you lived at your current address? *

What type of home do you live in currently? *

Single-family home

Apartment

Condominium

Townhouse

Duplex

Other*

*If other, please explain

Do you rent or own? *

Rent

Own

If you rent, have you obtained permission from your landlord to have a dog? *

Yes

Not renting

Renters, please note! If you are renting, please email documentation stating that you are allowed to have a dog (e.g., pet agreement, lease addendum, letter from landlord) to This email address is being protected from spambots. You need JavaScript enabled to view it.

In the subject line, include your name and "Rental Agreement". We will not be able to proceed with your application until we receive the documentation.

What is the weight restriction for pets in your rental home?

Are you planning a move in the near future? *

Yes*

*If you are planning a move, what will you do with your dog?

Do you have a fence? *

Yes, a physical fence

Yes, an electric fence

Yard is partially fenced/there are breaks in fence

No fence at all

What is the height of the LOWEST part of your fence? *

Under 3 feet

Over 5 feet

3-4 feet

Electric

4-5 feet

No fence

Indicate how you will exercise your dog. *

How will your dog be cared for if you are away from home (e.g .,military deployment, business trips, vacations, etc)? *

How many hours will this dog be alone per day? *

Where will the dog be kept when you are not at home during the day (e.g., in a crate, in a specific room or area, free roam in house)? *

Where will the dog be kept at night when you are sleeping (e.g., bedroom, crate, free roam in house)? *

Family Environment

How many adults live in your home? *

Adults' ages (separate by commas, youngest to oldest) *

How many children live in your home? *

Children's ages (separate by commas, youngest to oldest) *

Describe your children's experience with dogs. *

Are you currently expecting a child? *

Yes

At what age do you think it's acceptable to leave a child unsupervised with a dog? *

Does everyone in the family agree with adopting a golden retriever? *

Yes

No*

*If no, please explain.

Who will be considered the primary caregiver for your dog? *

Do you currently own a cat or cats? *

Yes

If yes, how many cats?

If you own a cat, is your cat friendly toward or experienced with dogs? *

Yes

No cats in household

Do you currently own a dog or dogs? *

Yes

If yes, how many dogs?

If you own a dog, is your dog friendly toward other dogs? *

Yes

No dogs in household

Are other cats/dogs currently in the home spayed and/or neutered? *

Yes, all cats/dogs are spayed or neutered

Yes, some cats/dogs are spayed or neutered

No cats/dogs are spayed or neutered

No other cats/dogs are in the home currently

Tell us about any animals currently in your home. *

Your Adopted Dog

Why do you desire to adopt a dog (check all that apply)? *

Personal Companion

Breeding

Child Companion

Gift

Personal Protection

Other*

Guard Dog

*If other, please explain.

Why do you want to adopt a rescued golden retriever? *

Do you see any disadvantages in owning/adopting a golden? *

What traits are you looking for in a dog? *

Preferred sex of your adopted golden *

Male

Female

Either

Preferred color of your adopted golden *

Golden

Red

Cream

No preference

Preferred age of your adopted golden (check all that apply) *

Puppy (we rarely get puppies)

1-4 years

5-8 years

Senior

What energy level would you like in your dog (check all that apply)? *

High

Medium

Low

Would you consider adopting a senior or special needs dog? *

Yes, I would consider a senior dog.

Yes, I would consider either or both.

Yes, I would consider a special needs dog.

No, I am not looking for these.

Would you consider adopting a golden mix? *

Yes

Would you consider fostering a dog with the possibility/intent of adopting that dog when medically cleared for adoption? *

Yes

Adult goldens are spayed or neutered and we require you to spay or neuter any adopted puppies. Explain any reservations you have about these policies. *

When would you like to adopt? *

ASAP

1-3 months

3-6 months

6-12 months

Are you willing to care for this Golden for the next 10 years or more? *

Yes

Are you aware that routine costs of maintaining a dog average $1000 to $1500 per year? *

Yes

I am able to afford all the expenses associated with caring for a dog. *

Yes

Previous Ownership Experience

Tell us about pets you've owned for the past five (5) years. Include type, sex, age, spay/neuter status, and where they are now. *

If you have had a pet die at an early age or due to an accident, please explain the circumstances. *

Do you currently take your pets for regular vet visits? *

Yes

No pets

If you currently own a dog, please provide contact information for your current vet. *

Are your current pets up to date on vaccinations, heartworm medications, and flea/tick preventatives? *

Yes

No pets

Have you ever potty trained a dog? *

Yes

Have you ever crate trained a dog? *

Yes

Have you ever obedience trained a dog? *

Yes

Have you ever adopted a rescue dog (check all that apply)? *

Yes, from SEVA GRREAT

Yes, from another rescue

If you have adopted from SEVA GRREAT before, please provide the name of your dog and the approximate adoption date. *

What challenges (if any) have you ever had with your previous rescue dog? *

If you have ever given up a dog to a rescue, to a shelter, or to another person, please explain the situation in detail. *

SEVA GRREAT Policies

Have you ever had an application rejected from a rescue or shelter? *

Yes*

*If yes, please explain.

Are you willing to travel up to 150 miles to visit a dog at a foster home? *

Yes

I understand SEVA GRREAT adoption fees. *

Yes, I understand the fees.

No, I will need more information on adoption fees.

I understand that submission of an application does not mean I will be approved to adopt a dog from SEVA GRREAT. *

Yes

I understand that before my application is approved, my home will be inspected by one of our SEVA GRREAT volunteers. *

Yes

I understand that even if I have a home inspection, my family may not be approved to adopt. *

Yes

I understand that if I am approved to adopt, my application will expire at the end of the year following the year in which I am approved. *

Yes

I understand that if I am invited by a foster to meet a dog, I may not be selected to adopt that dog. *

Yes

Please supply two references (name and phone) that we may contact during the approval and adoption process. *

Have you ever been convicted of an animal abuse crime? *

Yes

Additional comments. What else would you like us to know about you? *

I ACKNOWLEDGE ALL THE INFORMATION CONTAINED IN THIS FORM IS TRUE AND CORRECT. I UNDERSTAND THAT ANY MISREPRESENTATIONS OF FACT MAY RESULT IN MY APPLICATION OR ADOPTION BEING DENIED AND/OR THE REMOVAL OF THE ADOPTED DOG FROM MY HOME BY SEVA GRREAT. SEVA GRREAT RESERVES THE RIGHT TO REFUSE AN APPLICANT IF THE SITUATION IS INCOMPATIBLE WITH THE NEEDS OF A RESCUED GOLDEN RETRIEVER. *

Yes

How are you submitting the Adoption Application Fee? *

I paid via your PayPal Donate button on the top right side of this page. (If you did not pay before starting this application, please finish the application and click below to submit it BEFORE you pay.)

I am submitting a personal check. ****If you are submitting a check, please make it payable to SEVA GRREAT and mail to us at: PO Box 8014, Yorktown, VA 23693

Note: You do not need your own PayPal account to pay on this site. You only need a credit card.

COVID-19 WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against SEVA GRREAT and its owners, officers, directors, managers, officials, trustees, agents, volunteers, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing SEVA GRREAT’s services and premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen. *

Yes

Last Name