NOTICE:
Have you checked our coverage area on the home page map.

If you live in the Green zone your good.
If you live in the Yellow zone we need to speak to you.
If you live outside of the Green or Yellow zones you are to distant for us to assist you.
You can find adoption agencies in your area from this national greyhound link:
http://www.adopt-a-greyhound.org/directory/list.cfm

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HINT: You can copy and paste this page into a word processing program and print it,
Download file as: PDF, WordPerfect, MS Word 4.0, MS Word 6.0 /7.0, Rich Text.
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Name ________________________________ Daytime Phone __________________
Address _______________________________Evening Phone __________________
_____________________________________ EMail @ home __________________
_____________________________________ EMail @ work ___________________
How did you find us ______________________Clinic Date _____________________

1. In what type of housing do you reside?
___ Apt./Condo., ___ Townhouse, ___Single Family

2. Do you: ___ Own ___ Rent
If you rent, does your landlord permit dogs? ___ Yes ___ No ___ Not Sure
Would you permit us to contact your landlord? ___ Yes ___ No
Landlord's telephone number ___________ (We need written approval letter)

3. Do you have a fenced in yard? ___ Yes, Height ______ (in feet),
___ No. Are you able to leash walk dog at least 4 times a day for necessary functions?
___ Yes ___ No. Why not? ______________________________________________
NOTE: Invisible fences are unacceptable, due to the greyhound's speed and
other factors.

4. Makeup of household: ____ Adults ____ Children, Ages: _______________________

5. Does anyone in the household have allergies? ___ No ___ Yes, What type? _________

6. Which family member will have the major responsibility of caring for the dog? ________

7. How many hours a day would the dog normally be left alone? ____

8. How close is your nearest neighbor? _____________________________________
Is the Area? ___ City, ___ Suburban, ___ Rural

9. Will this be your first pet? ___ Yes ___ No
What pets did you previously own, if any? ___ Dogs ___ Cats ___ Other
What happened to them? ________________________________________________
What pets do you currently own if any? ____ Dogs, Breed _______________________
____ Cats ____ Other, what kind _________________________________________
If you currently own a dog(s), is it neutered/spayed? ___ Yes ___ No

10.Who is your veterinarian? ______________________________
Address ____________________________________________________________
Phone Number________________________________________________________

11.Why do you want to adopt a Greyhound? __________________________________
___________________________________________________________________

12.What sex do you prefer? ___ Female ___ Male ___ No preference

13.Where will your Greyhound spend most of its time? ___________________________

14. Are you willing to crate to train your Greyhound, if necessary? ___ Yes ___ No

15. Since Greyhounds bond closely to their owner, will you allow your Greyhound to sleep in
your bedroom? ___ Yes ___ No, why not? ___________________________________

16. Do you agree to keep your Greyhound on a leash or in a fenced-in area at all times and
never on a "tie out" stake? ___ Yes ___ No
NOTE: Invisible fences are unacceptable, due to the greyhound's speed and
other factors.

17. Do you agree to return your Greyhound to us if you are unable to keep it?
___ Yes ___ No
However this is not an escape clause for the adopter to use in the event of medical issues or
old age of the dog.

When you adopt a greyhound (it is a legal contract), it should be considered the same as
adopting a child (for life, through good and bad times). Remember this is not a trivial matter.
It is a contract for life so please discuss and fully consider this step carefully with all members
of the household. Do you agree with this statement? ___ Yes ___ No.

If you need to return a dog, Greyhound Rescue of New York, Inc. requires a signed release to
obtain historical medical records from your veterinarian(s) prior to accepting any dog.

Greyhound Rescue of New York Inc. reserves the right to review all provided and related
information including financial, based upon each unique request to return a dog, for determination
of acceptance or denial for return of that dog.

Do you agree with item 17 above in it's entirety and will be bound by said conditions
___ Yes ___ No.

18. Are you willing to keep the dog up to date on all shots, screen for heartworm, use heartworm
preventative and flea & tick preventative (such as Frontline Plus). Flea and tick collars are
unacceptable due to chemicals used and absorption thru the skin? ___ Yes ___ No.

19. Are you willing to license the dog and keep it properly identified
(ID tag and Greyhound Rescue tag)? ___ Yes ___ No

20. Are you willing to allow us to visit your home as part of this pre-adoption process?
___Yes ___No

21. Are you willing to provide us with follow-up reports? ___ Yes ___ No

22. Are you willing to volunteer your time to Greyhound Rescue of New York, Inc?
___ Yes ___ No
If yes, are you willing to: ___ Help at awareness clinics
___ Other __________________________________________________________
___________________________________________________________________

Please list any special skills or talents _______________________________________
___________________________________________________________________

23. Please use the space below to list 3 references (2 if you have a current veterinarian
BUT item 10 above must be filled out). Please include complete name, address and
telephone number.
1. _________________________________________________________________
___________________________________________________________________

2. _________________________________________________________________
___________________________________________________________________

3. _________________________________________________________________
___________________________________________________________________

I understand that a NON-REFUNDABLE TAX-DEDUCTIBLE $200.00 DONATION
WILL BE REQUIRED AT THE TIME OF ADOPTION

By signing this application, I(we) authorize the Veterinarian listed on this application to
release information to a representative of Greyhound Rescue of New York, Inc.

___________ ____________________________ ____________________________
Date, Applicant's Signature and Printed Name

___________ ____________________________ ____________________________
Date, Applicant's Signature and Printed Name

NOTE: Two signatures are required when there are two adults in the household.

FAX APPLICATION TO:
1-877-278-2194

MAIL APPLICATION TO:
Greyhound Rescue of New York, Inc.
P. O. Box 1527
Clifton Park, NY 12065

DROP OFF APPLICATION AT ONE OF OUR

AWARENESS CLINICS (Click Here)

www.greyhoundrescueofny.com ________________________________Form# pre-adoption application web-09152004
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HINT: You can copy and paste this page into a word processing program and print it,
Download file as: PDF, WordPerfect, MS Word 4.0, MS Word 6.0 /7.0, Rich Text.
____________________________________________________________________