⚠ All fields must be completed to ensure processing. I would like to:FosterAdopt Full Name Your Age Co-Applicant Name Co-Applicant Age Street Address City State: ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code: Home Phone Cell Phone Your Email Best time to call: ---MorningAfternoonEveningAnytime Place of Employment Why do you want to adopt a Great Dane: Do all household members want to adopt? YesNo Have you owned a Great Dane? YesNo What would be your preference in a Great Dane? No PreferenceSome Preference Please explain: (color, age, gender, etc) Do you consider yourself/family to be active in such a way that it would include your Dane? YesNo Please explain: Please list name and ages of all humans in your household: Please list all dogs current and previous (name, gender, age, breed, spay/neuter, living/deceased): If your dog is not spay/neuter please explain why: Please list all cats current and previous (name, gender, age, breed, spay/nueter, living/deceased): If your cat is not spay/neuter please explain why: Other animals? Have you ever sold, rehomed, surrendered or put down a pet? YesNo If yes, please explain: If there are no children living in your home, will your rescue Dane have regular contact with any children under the age of 10? YesNo If yes, please explain: If there are no other pets living in your home, will your rescue Dane have regular contact/socialization with others? YesNo Please explain: Does anyone in your household have allergies or asthma? YesNo If yes, who and what kind: Are you aware that dogs can shed all year around? YesNo Who will care for, train and exercise your Dane? How will you exercise your Dane? If you do not currently have a dog, have you ever owned a dog in the past for which you were the primary caretaker? YesNo If yes, please explain: Name of Veterinarian? Note: If you do not currently have a pet, please list past vet info and/or who you intend to use. Veterinarian Address? Veterinarian Phone? Do you own or rent your home? OwnRent How long at current residence? If you rent, has the property owner provided written permission for you to have a large breed? YesNo Please provide the property owners name and contact number: Do you have a fenced yard? YesNo If yes, please describe (Completely Enclosed, Shade, Height, Gates): Where will the Dane live? Where will the Dane sleep? Where will the Dane eat? Will the Dane be allowed on furniture? YesNo Will the Dane be allowed free run of the house? YesNo How many hours per day will your dog be home without humans on a regular basis? Where will the Dane be kept when you are not home? Are you familiar with the use of a dog crate to train and/or confine the dog during your absence or at night? YesNo Are you planning to use a crate? YesNo What do you do with your pets when your away from home overnight? Are you aware that costs for maintaining a Dane can average $1000 or more per year (food, annual check ups, shots, heartworm and flea/tick preventatives, grooming, etc) YesNo Will the Dane be walked daily? YesNo Have annual check ups? YesNo Receive formal obedience training, if needed? YesNo If you move, what will you do with your Dane and other pets? Would you allow follow up home visits from a rescue representative before and after adoption? YesNo Are you aware of and do you understand the state/local ordinances concerning dog licensing and leash laws? YesNo Has any member of your household been cited for licensing or leash law violations? YesNo If yes, please explain: Will you call SSGDR at the onset of any type of illness or health problems within 30 days following adoption? YesNo What would you do if one of your pets requires significant medical attention that was out of your price range? Personal Reference One: Please don't list family (name, phone, email, relationship, years known) Personal Reference Two: Please don't list family (name, phone, email, relationship, years known) Are you willing to give the new Dane at least 30 days to ensure proper adjustment? YesNo If no, please explain the conditions you would return: Have you researched Great Danes? YesNo Any questions or comments to the rescue? If a Great Dane is placed with me/us, I/we agree to cooperate with Southern Style Great Dane Rescue in its attempt to provide a smooth adoption. I also agree to contact SSGDR about problems that might arise in the future. Should the dog need to be removed, or euthanized (prior to normal old age), I/We will contact Southern Style Great Dane Rescue first to determine whether the dog might be a candidate for placement elsewhere. By submitting this application, I certify that the information that I have provided is true, correct and complete to the best of my information and belief and that I have not willfully concealed any information in answering the above questions.