RESIDENCE INFORMATION
	Other residents besides spouse and children	Parents Siblings Housemates Staff Other	Please explain
	Type of residence	Apt/Condo Townhouse Trailer Single Family Farm Other	Please explain
	Do you	Own Rent	Landlord name Landlord phone ext.
	Are there any size or weight restrictions on pets where you live?	Yes No
	Location of residence	Rural Suburban Urban
	How long have you lived at this address?	Months Years
	Do you plan to move in the next year?	Yes No	Please explain
	Size of living area	sq. ft.
	Size of yard
	Fenced yard	Yes No	Type of fence Height of fence ft. How do you plan to exercise the dog and give it potty breaks?
	Leash walks	Frequent Occasional None
	In-ground pool	Yes No	Will the dog have access to the pool? Yes No

PET INFORMATION
	How many hours will the dog be alone per day?
	During what time frame(s)?
	Where will the dog be kept when family is:	home? gone for work, shopping, etc (not vacations)?
	Will you permit a home check?	Yes No
	Is there any aspect of your home a puppy/dog could affect (white carpet, antiques, etc.)?	Yes No	Please explain
	Does anyone in your family have	allergies to hair/dust Yes No physical impairments Yes No
	Are you often away for extended periods?	Yes No
	When away for extended periods, do you	N/A Board dog Take dog with you Other	Please explain
	How many dogs do you own?	0 1 2 3 4 5 or more
	Dog 1 Name Breed Gender   Male Female Age years months Spayed/Neutered Yes No Dog 2 Name Breed Gender   Male Female Age years months Spayed/Neutered Yes No Dog 3 Name Breed Gender   Male Female Age years months Spayed/Neutered Yes No Dog 4 Name Breed Gender   Male Female Age years months Spayed/Neutered Yes No
	Are your dogs on Heartworm Preventative?  Yes No		What Kind?   Proheart 6 Heartgard Interceptor Revolution Sentinel Other What kind?
	Do you own any other pet(s) besides dogs?	Yes No	What kind?
	Are you planning on getting new pets in the near future?	Yes No	How soon and what kind?
	Have you owned any dogs in the past?	Yes No
	Have you ever owned a giant breed dog before?	Yes No	Which breed(s)?
	What was the disposition of prior dogs?	N/A Ran away Stolen Sold Given away Given up for adoption Euthanized Died Other	Please explain
	Why do you want a Great Dane?
PREFERENCES
	Gender	Doesn't matter Male Female
	Color	Doesn't matter Black Blue Boston (Mantle) Merle Fawn Brindle Harlequin
	Size	Doesn't matter Extra Large Large Medium
	Ears	Doesn't matter Cropped Un-cropped
	Age	Doesn't matter 8 weeks Young adult Mature adult
	Temperament level	Doesn't matter Natural Leader Follower Friendly Aloof Outgoing Demands Attention
	Activity level	Doesn't matter High Moderate Low
	Would you accept a Great Dane mix?	Yes No Depends on mix
	Some rescues have pre-existing health conditions or problems that may require further care by the adopter (skin problems, cataracts, etc.). Would you adopt a dog that has health problems?  Yes No Maybe
	Are you aware of the yearly costs of maintaining a healthy dog? Yearly vaccines can be $70-$100. Then there is heartworm preventative (daily or monthly), flea/tick control (pet and premises), dental care, food, accessories, as well as many other unforeseen items/circumstances (such as accident or illness). Are you prepared to meet these requirements? Yes No
	How far are you willing to travel to pick up the dog?
	How soon do you want to adopt the dog?
	Are you willing to spay or neuter your pet?	Yes No
	Are you willing to take your dog to obedience training?	Yes No
	How much adult supervision of the dog and your children will be provided?	N/A Maximum Some Minimal None
	If no children reside with you, how often will your dog come in contact with children?	Often Occasionally Never
	If neighbors have children, how old are they?
	How much adult supervision of the dog and neighborhood children will be provided?	Maximum Some Minimal None
	Some dogs are lively and curious in the house. They like to play with you and follow you around. Will a dog like this annoy you?  Yes No
	How would you encourage and reinforce your dog's appropriate or good behavior?
	How would you prevent and manage your dog's inappropriate or bad behavior?
	Who will be the primary caretaker of the dog?
	Are all members of your household aware that you are acquiring a new dog?	Yes No
	Do they all approve?	Yes No
	Are all willing to be somewhat involved in the care and raising of this dog?	Yes No
	Have you ever crated a dog?	Yes No
	Are you willing to crate this dog if needed?	Yes No
	Do you already have a crate for your new dog?	Yes No	What size?
	Are you willing to an adoption fee to help defray expenses associated with rescue: $225?	Yes No
	Which Great Dane(s) are you interested in?
	Other comments

REFERENCES
	May we check with these references?	Yes No
	Veterinarian Name
	Veterinarian Street Address
	Veterinarian City
	Veterinarian State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Zip -
	Veterinarian Phone	ext.
	Trainer Name
	Trainer Phone	ext.
	Dog Club Name
	Dog Club Phone	ext.
	Other
	Other Phone	ext.
I ATTEST THAT ALL ANSWERS THAT I HAVE PROVIDED ON THIS APPLICATION ARE CORRECT. I UNDERSTAND THAT GREAT DANE RESCUE NE FLORIDA HAS THE RIGHT TO REJECT ANY APPLICANT FOR ANY REASON. I agree with this privacy notice: Great Dane Rescue of NE Florida may share your application information with other rescue organizations as part of the approval and screening process. Great Dane Rescue of NE Florida will NEVER sell your information or share it with any other outside resources.
Yes No
Type Applicant Name to serve as signature
Type Co-Applicant Name to serve as signature