Golden Retriever Rescue of Mid-Florida, Inc
PO Box 1449, Goldenrod, FL 32733-1449
Voice Message Info Line: (407) 332-2840
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Intake Volunteer Form

Please fill in this form as completely as possible.

All questions must be answered--if not applicable or you don't know, enter N/A.

Name of Volunteer:
Email address:
 Surrendering Owner Information
Surrendering owner's name:
Zip Code:
Phone #:
(with area code)
  Dog Information
Dog's Name:  
Sex:  Male   Female
Age:            Weight:  lbs
Is this dog spayed/ neutered? Yes       No  
Where did you get this dog?
How long have you had this dog?
Is it a purebred? Yes     No    I don't know
Do you have AKC papers? Yes     No    I don't know
Is the Pedigree available? Yes     No    I don't know
Are vaccinations current? Yes     No    I don't know
Which vaccinations are current?
Veterinarian Name:
Veterinarian Address
Is the dog on heartworm preventative?
Yes     No   I don't know

If Yes, what brand of heartworm preventative?

What date was heartworm preventative last given?

Has this dog ever had a seizure:

Yes      No  I don't know

If Yes, how often does the dog have seizures?

If Yes, what medication is the dog on for seizures?

Does the dog have any ear problems?

Yes    No   I don't know

List any orthopedic problems such as hip dysplasia, arthritis, stiffness or difficulty moving around:

Condition of skin -- any allergies?

Yes    No   I don't know

Please list any other medical conditons:

  Behavior Assessment

What is your dog's disposition?:

Is this dog confident or shy?

Can you:   Take food away? Take toys away? Take bones away?  

Does the dog:  Dig?  Chew?   Escape from yard?   Escape from house?

Ride well in cars?   Swim?        Run away?     Jump fences?

Bark a lot?    Steal food/items off counters or tables?      Jump on people?

Afraid of thunderstorms?  

If Yes, what does this dog do during a thunderstorm?

Is this an inside or outside dog?    inside   outside    

Is this dog housebroken?      Yes    No   I don't know

Is this dog crate trained?      Yes     No    I don't know
Does this dog get along with:  Children?   Yes     No  Other dogs?   Yes    No
 Cats?     Yes    No   Other animals?     Yes    No
Is this dog aggressive towards other dogs?   Yes     No
If Yes, what did the dog do to make you think it didn't like the other dog? 
Is the dog possessive over food dish? Yes     No    I don't know
Has your dog ever lived with children? Yes     No  
If Yes, for how long?   What were/are their ages?
How did the children treat the dog?
Does the dog accept:
Strangers?   Yes     No       Men?  Yes    No     Women?   Yes    No
Is there anywhere the dog does not like to be touched?
Has your dog ever growled at or bit a person? Yes     No
Has your dog ever growled at or bit another animal such as a dog or cat? Yes     No
Has your dog displayed any other signs of aggression? Please describe below or enter N/A:
Does the dog like to grab your arm or clothes (mouthy)? Yes     No
If Yes, explain:
Does your dog like to chase bikes or cars? Yes     No I Don't know
What does your dog dislike:
What is your dog afraid of?
Has it been to obedience school? Yes     No
If Yes, which obedience school?  
Does it know any commands? Please list: 
What are your training methods? Please describe:
Have you ever disciplined your dog when he/she has done something wrong? Please describe:

 Home Environment Assessment
Has your dog ever lived with: Other dogs? Yes     No     Cats? Yes     No
How do you exercise your dog?
Is the dog used to being home alone during the day? Yes     No
If Yes, how many hours on average? 
Does your dog have separation anxiety? Yes     No
What kind of food is the dog eating now? 
Is the dog on any vitamins or supplements? Please list:

 Additional Comments:
Why are you giving up your dog? (Please be as detailed as possible.)
What are your dog's bad points? (Please be honest: We know he/she isn't perfect or you wouldn't be considering turning him/her over to rescue.)
What are your dog's good points?
Please note: Please note that GRRMF does not buy or pay for dogs. This is a service to help place your golden retriever in a new home. Our services are free; however, a $100.00 donation to help pay for expenses is appreciated.

Next Steps:
Please read through the form again to ensure you have been as thorough as possible! It will improve your dog’s chance to find a new home. Once the form is submitted a volunteer will be in contact with you to discuss any questions you may have about our process or that we have about your dog.

GRRMF is an all-volunteer organization, so we ask for your patience. We are all volunteers and have full time jobs, please be patient. If we can not admit your dog into our program, we will be in contact within 48 hours. If we have room in our program, arrangements will be made for you to drop off your dog or for a volunteer to meet you.

We ask that you bring copies of any all veterinary records and any other necessary paperwork at the time you release the dog into our care. Please note that summer months and holiday periods are our busiest times. To expedite the process, you can e-mail photos of your dog to Please include the dog’s name in the subject line and your name in the body of the e-mail. The photo is only to verify that your dog is, in fact, a golden retriever and will help streamline this process.