Wisconsin Adopt A Golden Retriever Inc. Adoption Application

You must live in Wisconsin or within 60 minutes of the Wisconsin/Illinois border. You must be at least 21 years of age and you must pass a background check. Applications will remain active for "one year". You must call your veterinarian to “release your current or past pets' vet records” to WAAGR. All pets must be or have been up to date on vaccines and well taken care of, including heartworm preventative. (*Must be completed within 30 days of application submission.) You cannot have an aggressive resident dog at home. Wisconsin Adopt A Golden Retriever, Inc. (WAAGR) is a non-profit, all volunteer organization working in the state of Wisconsin to re-home golden retrievers and golden retriever mixes of all ages. WAAGR's main goal is to find appropriate, loving, forever homes for the dogs who may otherwise suffer abuse or death. WAAGR reserves the right to deny or rescind any adoption for any reason. ------------------------------------ PLEASE NOTE: A $35.00 Application Fee is "required" when submitting of your application. Payment can be received through our website, or via personal check at the address below. Please note that applications will not be fully considered complete until an application fee has been received. Applications fees are non-refundable. Wisconsin Adopt A Golden Retriever, Inc. 12605 W North Avenue #285 Brookfield, WI 53005-4629 414.517.7725 | waagr.org Seller License #: 268245-DS

Are you applying for a specific dog?

Today's Date:

First and Last Name:

First and Last (Legal name, no nicknames)

Middle Initial:

Date of Birth:

Have you previously adopted from Wisconsin Adopt a Golden Retriever?

Street Address:

City:

State:

Abbreviation (EX: WI for Wisconsin)

Zip Code:

Main Phone #:

Alternate Phone #:

Email:

Occupation:

If retired, previous occupation:

Do you live with a significant other or another adult in the home?

Do you currently own or rent your residence?

Own
Rent
None

If renting, Landlord Name:

If renting, Landlord Phone:

When is the best time to reach you by phone?

Example: Between ____ AM & ____PM.

Vet Clinic Name:

Doctor Name:

Vet Phone #:

Vet Address:

May we contact your vet for information about your pet's vet care?

Yes
No
Not applicable

Current Members of Household: ADULTS Please provide information on all adults (18+) who will reside at the residence of the adopted dog. List issues that may affect the ownership and care of having a resident dog (i.e. allergies, elderly, etc.). You will have an opportunity to tell us more about additional members of the household.

Please include: Name; Date of Birth; Gender; Health

{name}

How many children reside in the household?

Current Members of Household: CHILDREN Please provide information on all children who will reside at the residence of the adopted dog. List issues that may affect the ownership and care of having a resident dog (i.e. allergies, scared, etc.). You will have an opportunity to tell us more about additional members of the household.

Please include: Name, Age

{name}

What kind(s) of pets do you currently have in the household?

Select all that apply

Current Pets in the Household: Please provide information on all animals who will reside at the residence of the adopted dog.

Please include: Name; Age; Type (Dog, Cat, Other); Health

{name}

Two Personal References (no relatives please): Personal Reference 1 Name & Relationship:

Personal Reference 1 Phone Number

Personal Reference 2 Name & Relationship:

Personal Reference 2 Phone Number

Have you ever owned a dog before?

Have you ever fostered for a dog rescue or shelter?

Who will be the primary caretaker of your new dog?

{name}

Do all family members want a dog?

Where will the dog spend his/her days AND nights?

{name}

How long will the dog be alone daily?

Please Enter Number of Hours

Comments on hours:

{name}

Is your yard completely fenced?

Yes
No
Partially

If so, what kind of fence?

Fence height (in feet)

How will your dog be exercised & socialized?

{name}

What brand of food will you feed your dog? Where and when will you feed him/her?

{name}

Have you ever sold or given away a pet?

Yes/No (If Yes, please explain)

{name}

Are your current animals spayed or neutered?

Yes/No (If No, please explain)

{name}

Have you had any pets that died?

Yes/No (If Yes, please explain)

{name}

Please tell us about the dog you are looking for:

{name}

What age(s) will you consider?

Check all that apply

Do you have a gender preference for your pet?

Would you consider a mixed breed (versus golden mixed breed)?

Would you consider:

Select all that apply

Are you aware of the high cost ($800-$1,200/yr) of owning a dog?

Are you willing to crate train your new dog?

Will you groom the dog?

Will you take your dog to training classes?

If no, how do you plan to train?

Have you ever had a dog with Parvovirus in your home?

If so when?

Which volunteer areas would be of interest?

Select all that apply

Application Fee Payment A $35.00 Application Fee is required when submitting of your application. Please note that applications will not be considered fully complete until an application fee has been received. Applications fees are non-refundable.

Option 1: I have already submitted my $35 application fee and have a conformation of payment. Option 2: I have not yet processed my $35 application fee, but plan to process through WAAGR's online payment at WWW.WAAGR.ORG Option 3: I will send my $35 application fee via check to: Wisconsin Adopt A Golden Retriever, Inc. 12605 W North Avenue #285 Brookfield, WI 53005-4629

Option 1: Already paid
Option 2: Have not yet paid, but will online
Option 3: Have not yet paid, but will mail check

I understand that my application does not guarantee adoption.

I will contact WAAGR regarding any behavior or training issues. WAAGR may then refer me to a certified behaviorist who can/will evaluate the issue and offer insights on proper management or training.

Please initial below

WAAGR prohibits the utilization of electronic collars for training purposes.

Please initial below

Applicant Signature

Co-applicant Signature

Date

Waiver of Liability and Hold Harmless Agreement I/we, the undersigned, seek the opportunity to participate in WAAGR, and I/we therefore enter into this Waiver of Liability and Hold Harmless Agreement (“Agreement”) for valuable consideration. This Agreement shall legally bind me and the members of my household, including minors, and I am authorized to enter into this Agreement on their behalves. When this Agreement uses the words “I” or “me”, those words equally apply to each signatory below. By entering into this Agreement, 1. I acknowledge that I am familiar with dogs and the unpredictable nature of dog behavior. 2. I recognize and appreciate that certain risks of harm are or may be inherent in my participation in WAAGR and that WAAGR cannot control all of these risks. 3. I recognize and appreciate that some animals can pose dangers to people, other animals, and property. Such dangers may include, by way of example and not limitation, animals that can bite, trip, jump, knock down, and fight. Further, as additional examples, indoor and outdoor surfaces can become slippery, equipment can trip other persons, and/or some may fail to control their dogs. 4. I recognize and appreciate that activities involving animals may result in illness, injury, damage to property, and even death. 5. I recognize and appreciate that there are no guarantees regarding any dog’s training, health, behavior, temperament or disposition, background, age, ability, attitude, or ability to be trained. 6. I recognize and appreciate that any dog with which I may come into contact with, may be untrained, unhealthy, have biological or behavioral problems, have bad temperaments or dispositions, may have unknown backgrounds that include mistreatment or abuse, or may be strays with no past historical information available. Recognizing and appreciating these inherent risks associated with my participation in WAAGR, I nonetheless elect to proceed, and agree as follows: READ CAREFULLY! One of the purposes of this Agreement is for me to waive any claim or lawsuit that I may have against WAAGR and/or others because of any injury or harm, including, without limitation, property damage, bodily injury or other injury, infection and/or death arising from contact with WAAGR and others, interaction with or exposure to one or more dogs in a WAAGR program, and/or a visit to a WAAGR facility; provided, however, that the release shall not be effective for any property damage, bodily injury or other injury, infection and/or death that arises out of WAAGR’s intentional misconduct or gross negligence. PLEASE READ THE NEXT SECTION WITH PARTICULAR CARE. WAIVER, RELEASE, AND DISCHARGE FROM LIABILITY I, MY HEIRS, NEXT OF KIN, ASSIGNS, EXECUTORS, PERSONAL REPRESENTATIVES, ADMINISTRATORS, GUARDIANS, AND LEGAL REPRESENTATIVES AGREE TO FOREVER HOLD HARMLESS, WAIVE, DISCHARGE, AND RELEASE WAAGR, ITS OFFICERS, BOARD OF DIRECTORS, AGENTS, INSURERS, REPRESENTATIVES, EMPLOYEES, VOLUNTEERS AND/OR SHAREHOLDERS, SUCCESSORS AND/OR ASSIGNS, HEREIN AFTER REFERRED TO AS “RELEASEES”, FROM ANY AND ALL LIABILITY, CLAIM, DEMAND, DAMAGE OR CAUSE OF ACTION OF ANY NATURE WHETHER NOW IN EXISTENCE, WHETHER KNOWN OR UNKNOWN, OR HEREAFTER ARISING FOR ANY LOSS OF PERSONAL PROPERTY, ILLNESS, INJURY, DISEASE OR DEATH, ARISING OUT OF, OR RESULTING FROM MY PARTICIPATION IN ANY WAAGR ACTIVITY; OR ARISING OUT OF, RESULTING FROM, CAUSED BY, OR CONTRIBUTED TO IN WHOLE OR IN ANY PART BY ANY ACTION OR FAILURE TO ACT, NEGLIGENCE, BREACH OF CONTRACT, OR OTHER MISCONDUCT ON THE PART OF RELEASEES. I AGREE THAT WAAGR WILL NOT BE RESPONSIBLE FOR ANY MEDICAL OR VETERINARY COSTS ASSOCIATED WITH ANY ILLNESS, INJURY, DISEASE OR DEATH THAT I OR MY PETS MAY SUSTAIN IN CONNECTION WITH MY PARTICIPATION IN ANY WAAGR ACTIVITY, INCLUDING MY SERVING AS A FOSTER HOME FOR A WAAGR DOG. I UNDERSTAND AND AGREE THAT, IN THE EVENT THAT I AM A FOSTER HOME FOR A WAAGR DOG, WAAGR WILL NOT BE RESPONSIBLE FOR ANY VETERINARY COSTS ASSOCIATED WITH MY OWN ANIMALS BECOMING ILL, BEING HURT, OR OTHERWISE INJURED, OR KILLED AS A RESULT OF SAID WAAGR DOG BEING IN MY HOME, OR ELSEWHERE I MAY TAKE THE DOG AS PART OF MY FOSTER DUTIES. COVENANT NOT TO SUE I, my heirs, next of kin, assigns, executors, personal representatives, administrators, guardians, and legal representatives agree never to institute any lawsuit of any nature, any action at law, or otherwise against the RELEASEES; provided, however, that the aforementioned covenant not to sue shall not be effective for any damage caused by any RELEASEE’S intentional misconduct or gross negligence. Should any lawsuit or action at law or otherwise be instituted in violation of this Agreement, I, on behalf of myself, my heirs, next of kin, assigns, executors, personal representatives, administrators, guardians, and legal representatives agree that RELEASEES shall be entitled to recover, in addition to any other damages which may be incurred, all attorney fees and costs incurred in the defense of such actions, including appellate proceedings. INDEMNITY I, my heirs, next of kin, assigns, executors, personal representatives, administrators, guardians, and legal representatives agree to indemnify, defend, save, and hold RELEASEES harmless with regard to any and all losses, claims, actions, and proceedings of every nature whatsoever, whether known or unknown, which may be presented or initiated by any person or entity, arising directly or indirectly out of my participation in WAAGR, dogs in a WAAGR program, or any WAAGR facility; provided, however, that any indemnification obligation required under this Section shall not be effective with regard to any and all losses, claims, actions, and proceedings arising out of any RELEASEE’S intentional misconduct or gross negligence. CHOICE OF LAW This Agreement shall be construed in accordance with the laws of the State of Wisconsin. This Agreement shall not be interpreted against the RELEASEES merely because WAAGR may have drafted the Agreement. This provision negates the presumption that ambiguities should be construed against the drafter. VENUE The forum and venue for all disputes arising out of or relating to this Agreement shall be the Waukesha County Circuit Court in the State of Wisconsin. BINDING AGREEMENT In the event any portion of this Agreement shall be deemed not in compliance with Wisconsin law, the remainder of the Agreement shall remain in effect and be legally binding. I understand that I am free to consult with an attorney of my choosing before entering into this Agreement. I understand all of the terms of the Agreement and have been given adequate time to consult with my attorney to discuss any terms that I may not understand. I hereby willingly, knowingly, and voluntarily agree to the Agreement. BY SIGNING THIS AGREEMENT, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Waiver of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and in the event there are persons under the age of eighteen (18) living in the household, I as their parent or legal guardian am also signing on their behalf. I execute this Waiver of Liability and Hold Harmless Agreement for full, adequate, and complete consideration fully intending to be bound by the same. Signed the date selected below. Every adult eighteen (18) years of age or older residing in your home must print and sign below. Parents and/or guardians for anyone in their care under the age of eighteen (18) years of age by signing below are also signing on their behalf. Signature

PAY APPLICATION FEE HERE https://www.waagr.org/product-page/adoption-application-fee If fee not paid within 10 days of application, the application will not be added to our waiting list. (Previous WAAGR adopters are the "only" people exempt from our application fee.) WAAGR uses Pawlytics as its animal rescue management software. Please check the box below to indicate you have read and agreed to the Pawlytics Terms and Conditions for submitting your online application.

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