Date:

 

Name:

 

Address:

 

City, State, Zip, (County):

 

Home Telephone:

 

Business Telephone (s):

 

Your Email Address:

 

Best Time to Call at Home:

 

Best Time to Call at Work:

 

Occupation (s) / Employer (s) /  Time in position (s):

 

List names & ages of all children living in the home:  Please note:  You will be asked to read the book, 
"Child Proofing Your Dog" by Brian Kilcommons if you have you have young children.

 

List the names, ages & relationship of all other persons living in your home:

 

Do you or anyone in your household have allergies and specifically allergies to dogs.
          Yes No

How did you hear about GreytHounds of Eastern Michigan:

 

Have you ever met a retired racing greyhound:

Yes No

 

Why do you want to adopt a retired racing greyhound:

 

Are you willing to spend the funds necessary for greyhound ownership:

Yes No

 

Do you agree to keep this dog on good nutritionally balanced dog food:
         Yes No
 

Do you agree to keep this dog on Heart Worm preventative year round and to
make sure shots and other medical needs are up to date?
         Yes No
 

What is the activity level of your household: 

Quiet Moderately Active Very Active

 

How many hours per day will your greyhound be home alone?

1 2 3 4 5 6 7 8 9 10 11 12
 

Where will your greyhound stay when home alone:

 

Where will your greyhound sleep at night:

 

Do you have other pets and if so, what breed, sex, age, and spayed /  neutered:

Please list previously owned pets and what happened to them.  

 

Do you live in a:
        Single Family Home Apartment Condominium Mobile Home Other
 

Do you own or rent:
        Own Rent
 

Do you have permission from the landlord or condo association to have a dog:

Yes No Unsure N/A

 

If required, will you provided written permission from the appropriate party:

Yes No N/A

 

Do you have a fenced yard:
        Yes No

           If Yes to Fence, please list type, size of yard and height:  
           (Please place N/A in this field if it does not apply)

 

Are you willing / able to provide on-leash walks with your greyhound frequently?

Yes No

 

Who will be the primary caretaker of the greyhound:

 

On a scale of 1-5 (5 being the highest) How would you rate your knowledge of dog behavior:

1 2 3 4 5
 

GEM is an adoption and support organization.  May we periodically contact you to maintain our database after your adoption:

Yes No
 

Does your family anticipate any major lifestyle changes in the next year, please explain:
(Examples: retirement, moving, new jobs or schedule change)

 

What do you consider a valid reason for giving up a pet: (Choose primary and list all others in narrative)

Barking Biting Chewing Destructiveness Digging Moving House Remodeling Expense Having a Baby Too Rough with Kids Unable to Housebreak Other NONE  

Please explain: 

(Please place N/A in this filed if it does not apply)

 

Are all members of the household in total agreement with this adoption:

Yes No

If No, please explain:  

(Please place N/A in this field if it does not apply)

 

Have you applied to another rescue group?  GEM does NOT compete with
other rescue groups:

Yes No

If Yes, please explain why you are now applying to GEM:  

(Please place N/A in this field if it does not apply)

Occasionally, an older dog,  or previously injured dog or special needs dog becomes available.  
Would you be willing to consider such a dog:

Yes No Previously Injured Older 5 to 6 years Older 7 or more

Do you understand that this greyhound may not be completely house trained and are you willing to take the time and energy necessary for house training?

Veterinarian: (Please list name, complete address and telephone number)

 

May we contact your veterinarian as a reference:

Yes No
 

Please provide 2 personal references:

Reference #1 (name-address-telephone):

Reference #2 (name-address-telephone):

 

Have you read either of these required reading books?
"Adopting the racing Greyhound" by Cynthia Branigan (ISBN 0-7645-4086-6)
-or-
"Retired Racing Greyhounds for Dummies" by Lee Livingood (ISBN 0-7645-5276-7)
        Yes No

May we conduct a in home interview:
        Yes No